Clinical value of 12-lead electrocardiogram after successful reperfusion therapy for acute myocardial infarction
Clinical value of 12-lead electrocardiogram after successful reperfusion therapy for acute myocardial infarction
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DOI：
10.1016/s0140-6736(96)07120-6
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发表时间：
1997-08-30
期刊：
影响因子：
168.9
通讯作者：
Zijlstra, F
中科院分区：
文献类型：
--
作者：
vantHof, AWJ;Liem, A;Zijlstra, F
背景：对于心肌梗死后成功接受再通治疗的患者来说，一种简单的临床风险分层方法很有吸引力，因为它便于治疗的量身定做。方法我们调查了403例首次冠状动脉成形术成功再通患者的12导联心电图(EGG)的临床价值，以及与酶活性、左心功能和临床结果的关系。结果：51%的患者ST段恢复正常，34%的患者ST段部分恢复正常，15%的患者ST段恢复正常。酶促心肌梗死范围和射血分数与ST段早期消退程度有关。与ST段正常者相比，未消退患者死亡的相对风险为8.7(95%可信区间3.7~20.1)，部分消退患者与ST段正常者相比死亡的相对危险度为3.6(1.6~8.3)。初次血管成形术再灌注治疗成功且ST段恢复正常的患者，在随访期间对心肌的损害有限，前景良好。再灌注治疗后持续ST段抬高的患者可能需要额外的干预，因为他们有更广泛的心肌损害和更高的死亡率。
Background A simple clinical method to stratify risk for patients who have had successful reperfusion therapy after myocardial infarction is attractive since it facilitates the tailoring of therapy.Methods We investigated the clinical value of the 12-lead electrocardiogram (EGG), in 403 patients after successful reperfusion therapy by primary coronary angioplasty, in relation to infarct size measured by enzyme activity, left-ventricular function, and clinical outcome. ECGs were analysed to find the extent of the ST-segment-elevation resolution 1 h after reperfusion therapy.Findings A normalised ST segment was seen in 51% of patients, a partly normalised ST segment in 34%, and 15% had no ST-segment-elevation resolution. Enzymatic infarct size and ejection fraction were related to the extent of the early resolution of the ST segment. The relative risk of death among patients with no resolution compared with patients with a normalised ST segment was 8.7 (95% CI 3.7-20.1), and that among patients with partial resolution compared with patients with a normalised ST segment was 3.6 (1.6-8.3).Interpretation Our findings suggest that ECG patterns reflect the effectiveness of myocardial reperfusion. Patients for whom reperfusion therapy by primary angioplasty was successful and who had normalised ST segments had limited damage to the myocardium and an excellent outlook during follow-up. Patients with persistent ST elevation after reperfusion therapy may need additional interventions since they have more extensive myocardial damage and have a higher mortality rate.