Transient ischaemia after acute myocardial infarction: relationship to exercise ischaemia

To study the implications of transient myocardial ischaemia following acute myocardial infarction we compared ambulatory ST segment monitoring with exercise treadmill testing in 170 patients (mean age 58 years) at 4-8 weeks after admission. Ambulatory monitoring detected transient ischaemia (265 episodes; 249 (94%) silent) in 53/170 patients (31%) which was less frequent than ischaemia during exercise testing (90 patients; 53%) (P less than 0.0001). However, patients displaying transient ambulatory ischaemia (i) achieved less total exercise (248.7 +/- 17.2 vs 318.7 +/- 14.1 s; means +/- SEM) (P less than 0.006), (ii) developed exercise ST deviation earlier (172.4 +/- 14.3 vs 244.8 +/- 16.2 s) (P less than 0.0004) and (iii) had more widespread exercise ischaemia (3.8 +/- 0.3 vs 2.5 +/- 0.2 ECG leads) (P less than 0.005). Positive ambulatory ST segment monitoring was infrequently found (12/80 patients; 15%) in the presence of a negative exercise test but did identify the majority of patients (9/11 patients; 82%) with easily provoked exercise ischaemia and hence strongly positive exercise tests. These data suggest a limited role for routine 24 h ambulatory monitoring after myocardial infarction for the diagnosis of ongoing ischaemia but raise the possibility of an important place for this test in prognosis and risk stratification.     

急性前壁心肌梗死时下壁导联ST段压低的临床意义

目的 :探讨急性前壁心肌梗死合并下壁导联 ST段压低的临床意义。方法 :回顾性分析2 2例首发急性前壁心肌梗死患者的心电图、冠状动脉及左室造影资料。结果 :急性前壁心肌梗死时下壁导联 ( 、 、a VF) ST段下移≥ 0 .0 5 m V组与 <0 .0 5 m V组的 、a VL导联 ST80 值有显著性差异 ( P <0 .0 5 ) ;两组的左前降支 6段 ( LAD6 )或 LAD始部病变的发生率也有显著性差异 ( P <0 .0 5 ) ;下壁导联 ST段压低≥ 0 .0 5 m V对 L AD6 或 LAD始部病变预测价值的敏感性及特异性分别是 : 导联 5 9%、5 0 % ; 导联 83%、70 % ;a VF导联 83%、70 %。结论 :急性前壁心肌梗死时下壁导联ST段压低预示 LAD6 或 L AD始部病变是高前侧壁发生透壁性心肌缺血的“镜像”反应 ,表现为 、a VL导联 ST段抬高 ;它与右冠状动脉、左旋支、多支病变以及胸前导联 ST段抬高程度无关     

Prognostic significance of silent myocardial ischaemia during maximal exercise testing after a first acute myocardial infarction

Clinical, exercise, and angiographic variables, and long-termfollow-up were compared in patients, who, during maximal Bruceexercise testing after a first acute myocardial infarction (AMI),had positive responses to exercise testing (n = 116, 38% of303) with (n % 23, group I) or without (n = 93, group II) angina.Group I patients more often (52 vs 19%, P < 0.001) had ahistory of pre-infarction angina. Group II had a greater proportion(75 vs 52%, P < 0.05) of inferior wall AMI, whereas groupI had a greater proportion (30 vs 19%, P < 0.01) of non-Qwave AMI. Total exercise duration was significantly (P <0.01) longer in group II (7.6 ± 3.2 vs 5.5 ± 3.1min). Maximal exercise heart rate (144 ± 22 vs 133 ±21, beats . min^–1 P < 0.05 was also higher in groupII. A greater proportion of group II patients (37 vs 9%, P <0.05) had single-vessel disease, whereas multivessel diseasewas more common (91 vs 63% P < 0.03) in group I. Left ventricularfunction was similar in both groups. During follow-up (48 ±22 months) the incidence of cardiac death (group I, 3.3%, groupII, 4.8%), of recurrent infarction (group I, 4.8%, group II3.3%), and of revascularization procedures (group I, 28.5%,group II, 19.8%) were similar in both groups. Although asymptomaticexercise-induced ischaemia was associated with better exerciseperformance and less extensive coronary disease than symptomaticischaemia, it had the same long-term prognostic implications.     

Prognostic value of ambulatory ST segment monitoring compared with exercise testing at 1-3 months after acute myocardial infarction

The relative value of ambulatory ST segment monitoring for assessingprognosis following acute myocardial infarction is currentlyuncertain. Ambulatory monitoring was performed in 177 patientsat a mean of 38 days (range 22–93) post-myocardial infarctionand its prognostic value was compared with exercise treadmilltesting (n=170). Cardiac events (myocardial infarction, cardiacdeath or coronary revascularisation) were noted during at least1 year of follow-up. The presence or absence of ST depressionon ambulatory nonitoring did not predict increased fatal ornon-fatal cardiac events although more severe ST depressionhad some predictive power: after adjusting for clinical variablesand coronary prognostic indices, the duration/24 h (P=0·03)and magnitude (P=0·007) of ST depression had independentvalue. ST deviation on exercise testing was associated (P<0·05)with increased events (19/90; 21% vs 7/80; 9%) and in patientswith a positive exercise test ST depression on ambulatory monitoringdid not identify any additional events (8/41; 20% vs 11/49;22%). No factor available from ambulatory monitoring was predictiveof outcome once variables from exercise testing were taken intoaccount. Ambulatory ST segment monitoring performed in the laterecovery phase (1–3 months) after acute myocardial infarctionis inferior to exercise testing for predicting prognosis anddoes not increase the predictive power of an exercise test.Ambulatory monitoring may only be indicated in patients unableto perform an exercise test.     

Effect of fluvastatin on ischaemia following acute myocardial infarction: a randomized trial.

AIMS: Residual ischaemia following acute myocardial infarction (AMI) is related to an adverse outcome, although the effect of early initiation of statin therapy is unknown. METHODS: A randomized, placebo-controlled, double-blind, parallel study was performed, which compared fluvastatin 80 mg daily with placebo in patients with an AMI and total cholesterol of <6.5 mmol.l(-1). Ischaemia was measured by ambulatory electrocardiographic (AECG) monitoring over 48-h at baseline, after 6 weeks and at 12 months. RESULTS: Five hundred and forty patients were included (83% male, age 61+/-11 years); 43% had an anterior AMI and 50% were treated with fibrinolytics in the acute phase. After 12 months, the total cholesterol (TC) level was reduced by 13% and LDL-C (low-density-lipoprotein cholesterol) by 21% (from 3.5 mmol.l(-1) to 2.7 mmol.l(-1)) in the fluvastatin treatment group. Both TC and LDL increased by 9% in the placebo group (P<0.001 between groups). At baseline, ischaemia on AECG was present in only 11% of patients, and absent in 77%; in the remaining 11%, recordings were technically inadequate. After 6 weeks, 32/48 (67%), and 12 months 35/46 (76%) of the patients with ischaemia on the baseline AECG, no longer showed signs of ischaemia. Nevertheless, ischaemia at baseline was predictive for the occurrence of any major clinical event (RR=2.35; 95% CI 1.39-3.2;P <0.001). Fluvastatin treatment did not affect ischaemia on AECG, nor the occurrence of any major clinical events as compared to placebo. Post-hoc analysis in patients with the most pronounced ischaemia at baseline showed a trend for a beneficial effect of fluvastatin on major clinical events (P=0.084). CONCLUSION: Residual ischaemia after AMI is observed less frequently in the present study, than in earlier studies, although it is predictive for future cardiovascular events. As a result, the present study was underpowered, and no effect of fluvastatin on AECG ischaemia, or major clinical events in the first year after AMI, could be detected. The present data do not confirm other reports which support widespread use of statin treatment early after AMI.     

Thrombolysis siginificantly reduces transient myocardial ischaemia following first acute myocardial infraction

In the second page of this paper, under the heading ‘Exercisetesting’, the second sentence should read: ‘A totalexercise time of 15 min was sought in each patient.’Insertionof the word ‘reached’ for ‘sought’ isa publisher's error, for which we apologise.     

Influence of residual myocardial ischaemia on induced ventricular arrhythmias following a first acute myocardial infarction.

OBJECTIVES: The purpose of this study was to assess the possible effect of residual myocardial ischaemia on induced ventricular arrhythmia during programmed ventricular stimulation in survivors of a first acute myocardial infarction. BACKGROUND: Most deaths after hospital discharge for acute myocardial infarction are sudden and presumably arrhythmic. Sudden cardiac death results from a dynamic interaction of structural abnormalities and transient triggering factors. The role of myocardial ischaemia as a trigger for ventricular arrhythmias remains unclear. We hypothesized that residual myocardial ischaemia after a first acute myocardial infarction is a potent trigger for sustained ventricular tachyarrhythmias, particularly in the presence of an abnormal myocardium. METHODS AND RESULTS: In this prospective study, programmed electrical stimulation, coronary angiography and dipyridamole-thallium-201 scintigraphy single-photon emission computed tomography were performed in 90 consecutive survivors of a first acute myocardial infarction. Patients, divided in two groups - group 1 with induced ventricular tachyarrhythmia (n=24) and group 2 without induced ventricular tachyarrhythmia (n=66) - were compared regarding residual myocardial ischaemia. The two groups were comparable in terms of mean left ventricular ejection fraction, infarct size and location, gender ratio, peak creatine kinase value, and extent of coronary disease. Residual myocardial ischaemia was detected in 32 patients: 15 (42.5%) belonged to group 1 and 17 (25.7%) to group 2. There was a statistically significant difference between the two groups regarding the presence and the extent of residual myocardial ischaemia (P<0.05). CONCLUSION: Residual myocardial ischaemia, revealed by dipyridamole-thallium-201 scintigraphy following a first acute myocardial infarction, might contribute to electrical instability evaluated by programmed ventricular stimulation.     

Residual myocardial ischaemia in first non-Q versus Q wave infarction: maximal exercise testing and ambulatory ST-segment monitoring

In a prospective study of 123 consecutive survivors of a firstmyocardial infarction (43 non-Q wave, 80 Q wave), we determinedthe total residual ischaemic burden by use of pre-dischargemaximal exercise testing and post-discharge 36 h ambulatoryST-segment monitoring initiated 11 ± 5 days after theinfarction. The prevalence of exercise-induced ischae-mic manifestations in the infarct types was similar: chest pain 14%vs 16% and ST-segment depression 54% vs 54%. The ischaemic thresholddid not differ either (heart rate at 1 mm of ST-segmnent depression120 ± 27 vs 119 ± 25 beats. min^–1). Duringearly post-discharge daily activities, more patients with non-Qwave infarction demonstrated transient episodes of ST-segmentdepression: 28% vs 14% (ns). Furthermore, ischaemic episodeswere significantly longer (42.5±50.1 vs 22.0 ±20.6 min; p <0.001), and the ischaemic threshold was significantlylower in non-Q wave infarction (heart rate at onset of ST-segmentdepression 84±11 vs 88±9 beats.min^–1; p<0.05). During 3.5±0.9 years of follow-up the proportionof patients with 1 ischaemic event (non-fatal reinfarction,angina pectoris, revascularization) was significantly higherin non-Q wave infarction (51%) as compared to Q wave infarction(31%) (P<005). In both infarct types the presence of ST-segmentdepression on ambulatory recording and exercise testing significantlypredicted the development of future angina pectoris, whereaspatients at increased risk for subsequent non-fatal reinfarctionor cardiac death were not identified.     

Relation of lateral ST-segment elevation pattern to myocardial salvage in patients with recanalized anterolateral acute myocardial infarction

BACKGROUND: Although anterior acute myocardial infarction (AMI) with ST-segment elevation in lateral leads is associated with a poor prognosis, the significance of the pattern of lateral ST-segment elevation has not been examined. HYPOTHESIS: The aim of the study was to examine the relation of the pattern of lateral ST-segment elevation to myocardial reperfusion and infarct size in patients with AMI. METHODS: We studied 111 patients who had a first AMI presenting with anterolateral ST-segment elevation and Thrombolysis in Myocardial Infarction (TIMI) grade 3 flow of the left anterior descending coronary artery within 6 h from symptom onset. Patients were classified into two groups according to the pattern of lateral ST-segment elevation on the admission electrocardiogram: Group 1, 42 patients with equivalent or greater ST-segment elevation in lead I than in lead aVL, and Group 2, 69 patients with lesser ST-segment elevation in lead I in than in lead aVL. Left ventricular ejection fraction (LVEF) was measured by predischarge left ventriculography. RESULTS: There were no differences between the two groups in age, gender, time from onset to recanalization, culprit lesion, or collateral development. Group 1 patients had a higher probability of impaired myocardial reperfusion as indicated by a myocardial blush grade of 0 or 1 after recanalization, a higher peak creatine kinase level, and a lower LVEF than Group 2 patients (p = 0.0001, respectively). CONCLUSIONS: We conclude that equivalent or greater ST-segment elevation in lead I than in lead aVL is associated with impaired myocardial reperfusion and less myocardial salvage in patients with recanalized AMI who present with anterolateral ST-segment elevation on the admission electrocardiogram.     

急性心肌梗死墓碑形ST段抬高的临床意义

目的探讨急性心肌梗死（acute myocardial infarction，AMI）墓碑形ST段抬高的临床意义。方法将86例AMI患者以ST段抬高的特征分为两组，墓碑形抬高组36例、其他形抬高组50例。观察两组的一般临床资料（年龄、有否合并糖尿病），并比较两组AMI的发生部位、PCI前心梗后心绞痛、并发症及死亡的发生率、首次CK值、各项心电指标及PCI后心肌缺血再灌注损伤的发生率。结果两组各项临床指标及心电图指标差异均有统计学意义；墓碑形ST段抬高组PCI后心肌缺血再灌注损伤的发生率亦明显高于其他形ST段抬高组。结论墓碑形ST段抬高患者梗死部位特殊而广泛、并发症多、死亡率高、易出现心肌缺血再灌注损伤，对此类患者应高度重视并积极预防心肌缺血再灌注损伤的发生。     

高血压并发ST段抬高型急性心肌梗死心电图特征对近期预后的影响

目的探讨高血压患者并发ST段抬高型急性心肌梗死心电图特征及对临床预后影响。方法选取1985年1月～2004年12月ST段抬高型急性心肌梗死合并高血压367例,以血压正常急性心肌梗死60例作为对照组。观察心电图指标及临床特征。结果观察组心房终未电势(PtfV1)负值增大(-0.04±0.01)mm·s,∑ST抬高振幅(21.7±4.2)mm,Q波导联数(6.7±1.3)个导联,QTc间期(450.5±50.2)ms,均与对照组有显著差异(p<0.05),对照组指标分别为(-0.02±0.01)mms,(12.1±2.9)mm,(4.0±0.8)个导联,(410.6±36.3)ms。观察组并发左心室肥厚35.2%,梗死后心绞痛45.5%,泵衰竭39.5%,严重心律失常57.5%,住院病死率30.8%,均高于对照组5%,18%,15.0%,26.7%,8.3%(p<0.05)。结论高血压心电图指标改变明显是影响急性冠脉综合征预后的高危因素之一。     

Prognosis following acute myocardial infarction in patients with ST-T abnormalities on electrocardiograms obtained before myocardial infarction

BACKGROUND: Many studies have examined the relationship between prognosis after myocardial infarction (MI) and electrocardiographic (ECG) findings at the time of or after the onset of MI. However, little work has been done concerning the association between ECG findings obtained before the onset of MI (pre-MI) and the prognosis after MI. HYPOTHESIS: The study was undertaken to determine whether ST-T segment and T-wave morphology on pre-MI ECGs provides useful information for prognosis after acute MI. METHODS: Pre-MI ECGs of 212 patients recorded within the 6-month period before MI were studied for the presence of high-voltage R waves, ST-segment depression, and negative T waves. The Kaplan-Meier method and multivariate analysis were used to determine the relationship between these ECG findings and in-hospital cardiac death. RESULTS: In-hospital cardiac death occurred in 32 (15.1%) patients. The in-hospital mortality rate was 38.5% (5/13) for the patients with high-voltage R waves, 54.5% (6/11) for patients with ST-segment depression, and 45.6% (15/33) for patients with negative T waves. The in-hospital mortality rate was 13.6% (27/199) for patients without high-voltage R waves, 12.9% (26/201) for patients without ST-segment depression, and 9.5% (17/179) for those without negative T waves. Multivariate analysis identified age and negative T waves as independent risk factors for cardiac death, with a hazard ratio for negative T waves of 3.1. CONCLUSION: Negative T waves on pre-MI ECGs represent an independent predictor of in-hospital cardiac death in patients with MI.     

Electrocardiographic criteria for predicting total occlusion of the proximal left anterior descending coronary artery in anterior wall acute myocardial infarction

BACKGROUND: Patients with occlusion of the left anterior descending coronary artery (LAD) proximal to both the first septal branch and the first diagonal branch may benefit most from early reperfusion therapy due to extensive area at risk. HYPOTHESIS: The aim of the study was to examine whether 12-lead electrocardiograms (ECGs) in the acute phase of acute myocardial infarction (AMI) could identify total occlusion of the LAD proximal to both the first septal and the first diagonal branch. METHODS: A 12-lead electrocardiogram was recorded on admission in 128 patients with anterior AMI within 12 h from symptom onset. Patients were divided into three groups according to the culprit lesion: 33 patients had total occlusion of the LAD proximal to both the first septal perforator and the first diagonal branch (Group P), in 51 it was proximal to either the first septal perforator or the first diagonal branch (Group D-a), and in 44 it was distal to both the first septal perforator and the first diagonal branch (Group D-b). RESULTS: Sensitivity and specificity of a greater degree of ST-segment depression in lead III than that of ST-segment elevation in lead aVL were 85 and 95%, respectively, which was better than the results derived by all other ECG criteria (p< 0.001). CONCLUSIONS: We conclude that a greater degree of ST-segment depression in lead III than that of ST-segment elevation in lead aVL is a useful predictor of proximal LAD occlusion in patients with anterior AMI.     

aVR导联ST段抬高对非ST段抬高型急性心肌梗死的意义

目的：探讨aVR导联ST段抬高（ ST segment elevation ,STSE）对于非STSE型急性心肌梗死（ acute myocardial infarction , AMI ）的预测价值。方法回顾性分析425例非STSE 型AMI患者的心电图资料,并观察各导联ST段压低情况及是否存在T波倒置。对所测定数据进行整理和统计学处理。结果 aVR导联STSE多见于完全性右束支阻滞、左心室肥厚以及V1导联STSE的患者,在其他导联广泛ST段压低的患者中也较为多见;此类情况在T波倒置患者中较少见。本研究中,22例在住院时死亡,其中5例死于心源性休克。患者住院死亡率的不断升高和aVR导联STSE的等级不断上升相关。多重变量分析表明,aVR导联STSE已经成为预测住院死亡的独立重要变量。 aVR导联STSE大都与住院患者的心肌缺血时间以及发生心力衰竭相关,但是与血清肌酸激酶或肌酸激酶同工酶 MB 的水平高低没有相关性。结论如果aVR导联STSE和严重冠状动脉病变之间的联系,能够在大样本非STSE型AMI患者群体中得到进一步验证,那么aVR导联STSE就可以成为选择早期介入治疗患者的一个较为有用的指标。     

ST段抬高型急性心肌梗死溶栓后心电图改变的临床意义

目的通过分析急性心肌梗死抬高的ST段下降幅度,评价溶栓治疗过程中ST段改变对患者心功能的预测价值。方法96例ST段抬高型急性心肌梗死患者,入院后行溶栓治疗,并计算溶栓后2h内ST段抬高振幅总和(ΣSTE)的下降幅度。结果溶栓治疗2h后,ΣSTE较溶栓治疗前下降大于50%时,病人自觉胸痛症状消失,心功能得到较好保护。而ΣSTE较治疗前下降小于50%时,患者心功能不同程度受损。结论ST段抬高型急性心肌梗死的患者经早期溶栓治疗后,其抬高的ST段下降幅度可作为心肌血供能否恢复的间接预测指标,从而能较准确地反映心肌再灌注情况及预测心功能状态。     

Unfavourable left ventricular remodelling in patients with dobutamine-inducible ischaemia after acute myocardial infarction.

AIMS: Aim of the study was to assess the role of early inducible ischaemia for determining left ventricular remodelling in patients with acute myocardial infarction. METHODS AND RESULTS: In 179 consecutive patients with first myocardial infarction the occurrence of new wall motion abnormalities during dobutamine stress echocardiography at discharge was related to the left ventricular volume changes at 6 months. Left ventricular end-diastolic and end-systolic index volumes (mL/m(2)) were echocardiographically detected at discharge and at 6 months and the relative changes were calculated. The study population consisted of 105 patients without and 74 patients with inducible ischaemia; of these, 46 patients had > or =4 ischaemic segments. At 6 months, the end-diastolic index volume increased in patients with inducible ischaemia compared to patients without (+7.5+/-11.2 vs -0.1+/-10.2 mL/m(2); P=0.0049) and final mean end-diastolic volume was greater in patients with inducible ischaemia than without (70.8+/-16.0 vs 61.1+/-17.0 mL/m(2); P=0.0012). The end-systolic volume increased at 6 months in patients with inducible ischaemia and it decreased in patients without (+2.8+/-8.6 vs -1.4+/-7.8 mL/m(2); P=0.021). At the multivariate analysis, inducible ischaemia in > or =4 segments (odds ratio=6.43), the wall motion score index at the peak of dobutamine infusion (odds ratio=1.14) and the end-systolic index volume at discharge (odds ratio=1.06) were independent predictors of subsequent left ventricular end-diastolic index volume increase > or =15 mL/m(2). CONCLUSION: In patients with first myocardial infarction the presence and the severity of inducible ischaemia, as detected by dobutamine stress echocardiography at discharge, indicates an unfavourable left ventricular remodelling.     

急性心肌梗死患者溶栓前ST段偏移总和值的预示价值

目的:探讨急性心肌梗死（AM I）患者溶栓前ST段偏移总和值对院内心功能情况的预示价值。方法:序贯入选我院心内科1997年2003年收治的首次发生AM I并接受溶栓治疗的患者,记录并对其临床资料进行回顾性分析。结果:符合入选标准的患者有136例,40例患者院内发生心功能不全,占29.4%。以溶栓前ST段偏移总和值将患者分为A组、B组、C组,组间比较:溶栓前ST段偏移总和值越高,患者院内心功能不全的发生率越高。Logis-tic多因素逐步回归分析显示:溶栓前ST段偏移总和值是该组患者院内发生心功能不全的独立危险因素,关联强度（OR值）为2.992（P=0.006）。结论:溶栓前ST段偏移总和值指标有助于早期识别发生院内心功能不全的高危AM I患者,以加强治疗,改善预后。     

The prognostic value of maximal exercise testing soon after first myocardial infarction

The prognostic value of ST-segment depression during maximalexercise test performed in the third to fourth week after acutemyocardial infarction (AMI), was studied in 126 consecutivepatients with no evidence of previous myocardial infarction,unstable angina pectoris or severe heart failure. All patientson average increased their pressure-rate product by 2.6 andno complications occurred. Within the first year of follow-up,major cardiac events occurred in 9 patients (20%), and werefatal in 6 (13%), of the 46 patients who developed ST-segmentdepression during exercise. Only 3 major cardiac events (4%)occurred in the 80 patients without exercise induced ST-segmentdepression. Depression of the ST-segment on maximal exercisewas a significant predictor of subsequent cardiac events inthese survivors of first AMI.     

Transient myocardial ischaemia: a multivariate analysis on clinical, angiographic and ergometric variables

The availability of ambulatory ECG monitoring allows identification of transient myocardial ischaemia, the clinical relevance of which is currently being investigated. Ninety-four consecutive patients with ischaemic heart disease and a positive exercise test (greater than or equal to 1 mm ST-segment depression) were studied to evaluate the prevalence of transient myocardial ischaemia (either painless or painful) during 24-h dynamic electrocardiogram (ECG) and the clinical, angiographic and ergometric variables predicting its appearance. Two-hundred-and-eighty-one episodes of transient electocardiographic myocardial ischaemia were recorded in 69 patients (73.4% of all patients). Transient myocardial ischaemia was more frequent, although not significantly so, in patients with diabetes, with previous myocardial infarction, or with multivessel disease. When tested by multivariate analysis, neither the clinical variables nor the severity of coronary artery disease allowed prediction of the occurrence of transient myocardial ischaemia during dynamic ECG. The duration of exercise testing up to the ischaemic threshold (ST-segment depression = 1 mm) and the peak heart rate during exercise were more accurate predictors of transient myocardial ischaemia (P = 0.019 and 0.012 respectively). Patients with transient myocardial ischaemia had a lower ischaemic threshold (355 +/- 175 vs 498 +/- 150 s, mean +/- SD, P = 0.001) despite a lower peak heart rate (129 +/- 18 vs 137 +/- 12 beats min-1, P = 0.047) than patients without transient myocardial ischaemia. In conclusion, exercise testing may help select patients for examination by dynamic ECG.(ABSTRACT TRUNCATED AT 250 WORDS)     

老年人急性心肌梗死心电图墓碑形ST段抬高临床特点和意义预后

目的 :研究墓碑形ST段抬高急性心肌梗死 （AMI）早期或超急性期严重心肌损伤的表现形式 ,探讨老年人近期预后。方法 :1981 0 1～ 1998- 12收治AMI患者 135 9例 ,根据心电图ST段抬高形式其中有墓碑形 6 5例 ,根据年龄分墓碑形老年阻 4 8例 ,非老年组 17例 ,另随机选通常形 6 0例为对照组进行多项指标分析。结果 :墓碑形组大量吸烟、基础疾病以高血压并发冠心病 ,前壁或复合前壁AMI发生率高 （P <0 .0 5 ）。墓碑老年组发生率 ,CK峰值 /Ptfv1负值增大 ,ST段振幅抬高 ,QTc间期延长 ,对应性ST段下移及并发恶性心律失常 /泵衰竭、梗死后心绞痛、心肌梗死扩展和 1周内病死率明显高于非老年组 （P <0 .0 5 ,P <0 .0 1）。结论 :墓碑形ST段抬高是AMI近期预后险恶的重要指标。