不同方法对肾功能评估的价值

目的探讨临床上常用的几种肾功能评估方法的相对准确性,寻求更为简便、快捷的肾功能评估方法。方法选择慢性肾脏病（CKD）患者80例,分别用^99mTc-DTPA肾动态显像法测定肾小球滤过率（GFR）,同时检测患者血肌酐（SCr）、血清胱抑素C（CysC）浓度,根据SCr分别用Cock-croft-Gault（C-G）方程和简化MDRD方程估算肾小球滤过率（分别为eGFR1、eGFR2）。按GFR值将患者分为4组,即A组：CKD1期;B组：CKD2期;C组：CKD3期;D组：CKD4期;排除CKD5期的患者。观察所有和各组患者eGFR1、eGFR2、SCr、CysC与GFR的相关性。结果总样本中,eGFR1、eGFR2与GFR呈正相关,SCr、CysC与GFR呈负相关（P〈0．01）。在各组中,A组：eGFR1、eGFR2、SCr与GFR之间均无明显相关性（P〉0．05）;而B、C、D组中eGFR1、eGFR2与GFR呈正相关（P〈0．01）,SCr与GFR呈负相关（P〈0．05）;CysC在A、B、C、D各组中均与GFR呈负相关（P〈0．01）。结论CKD2、3、4期患者eGFR1、eGFR2、SCr与GFR均有一定的相关性,但不论何期CKD患者,CysC均能准确反映其肾功能状况,且更加简便、快捷。     

活体肾移植供肾肾小球滤过率对受体早期肾功能的影响

目的 探讨活体肾移植供肾肾小球滤过率( GFR)对受体早期肾功能的影响.方法 2006年至2011年在本中心接受活体肾移植172例为研究对象,其中亲属供肾166例(96.5％),夫妻供肾5例(2.9％),帮扶供肾1例(0.6％).术前应用放射性核素99mTC-DTPA肾动态显像测定供体左右肾GFR.供体的双肾GFR为62～148 ml/min,将对象分为供肾GFR≤45ml/min受体76例和供肾GFR＞45 ml/min 96例.两组受体的透析情况、冷、热缺血时间、抗体诱导及免疫抑制方案、HLA错配率等基本资料相似.评价患者术后早期肾功能变化情况.结果 两组患者术后急性排斥反应以及肾功能延迟恢复( DGF)发生率差异无统计学意义.与供肾GFR≤45 ml/min组比较,供肾GFR＞45 ml/min组的Scr在术后1周、1个月、3个月、1年均较低,其中术后1周的差异有统计学意义(P＜0.05);术后1个月、3个月、1年的差异均无统计学意义.重复测量的方差分析显示术后1年内两组受体Scr变化差异无统计学意义.结论 活体肾移植供肾GFR高低对受体术后1周Scr下降水平有影响,供肾GFR高者受体术后1周Scr水平低,但是对受体术后早期(1年内)的Scr整体水平及变化趋势无显著影响.     

超声评估慢性肾脏病患者肾功能的探索

目的:分析慢性肾脏病(CKD)患者超声参数与估算肾小球滤过率(e GFR)的关系,探索评估肾功能的最佳超声参数。方法:选取我院收治的CKD1～5期肾功能稳定且未进入透析的97例患者,由同一名B超专科医师测量患者双侧肾脏长径、皮质厚度、实质厚度、皮质回声,计算CKD超声积分,并收集患者的一般资料、血生化指标、血红蛋白等。分析各超声参数与e GFR的相关性,并进行多因素分析。绘制接受者操作特征(ROC)曲线,并估计曲线下面积,评估超声参数识别CKD3期(e GFR <60 ml/min)患者的能力。结果:(1)本研究97例患者平均e GFR (50.9±35.7) ml/min,平均肾长(9.62±1.24)cm,平均肾实质厚度(1.51±0.29) cm,平均肾皮质厚度(0.69±0.16) cm,肾皮质回声中位值2,平均CKD超声积分(5.16±3.67)。(2) e GFR与肾脏长径(r=0.756,P <0.01)、实质厚度(r=0.739,P <0.01)、皮质厚度(r=0.715,P <0.01)呈正相关,与皮质回声(r=-0.786,P <0.0...     

终末期肾病患者开始透析时肾功能及相关因素分析

目的提供我国中等城市终末期肾病(ESRD)患者开始透析时肾功能水平的准确数据并分析相关因素,为选择合适的透析时机提供依据。方法查阅1998年1月至2004年8 月期间长沙市两大透析中心所有首次透析的终末期肾病住院患者的病案,其中514例数据齐全而人选并按不同条件分组。计算整组病例及各分组的平均Scr值、GFR预测值(eGFR)及其他统计指标,以及比较组间差异并与国外资料比较。结果 (1)男性较女性多;45岁以下患者占 50．4％;自费患者最多(55．4％),但比例逐年下降;医保患者占17．7％,而比例则逐年增高; 91．8％的患者选择血液透析为首次治疗方式;首位病因仍是肾小球肾炎(59．7％),其次为高血压肾病(10．9％)和糖尿病肾病(6．8%),肾小球肾炎患者所占比例逐年下降,而高血压和糖尿病患者的比例则逐年增高。(2)平均Scr浓度为(1121．92±458．24)μmol／L;平均eGFR为 (4．98±2．24)ml·min-1·(1．73 m2)-1。(3)年轻人、无费用保障的患者、无业或农民、在职人员、学生、选择血液透析的患者、原发病为非糖尿病的患者中,Scr值较高而eGFR值则较低,组间差异均有统计学意义(P<0．01)。男性患者的Scr和eGFR值均高于女性(P<0．01,P<0．05)。(4) 低白蛋白血症患者占总例数的53．1％。当eGFR<8．4 ml·min-1·(1．73 m2)-1时,eGFR与血清白蛋白(Salb)呈正线性相关(r=0．093,P<0．05)。(3)与美国1999年资料比较,本组514例患者的eGFR预测值低于美国患者(P<0．01)。结论本组以年轻男性患者多见。肾小球肾炎患者所占比例逐年下降,而高血压和糖尿病患者的比例则逐年增高。相当多的患者在肾功能非常差时才开始透析。患者普遍存在低白蛋白血症,eGFR下降到一定水平以后,Salb随eGFR下降而下降。本组514例ESRD患者开始透析的时机要较美国患者晚。     

吸烟对特发性膜性肾病患者肾功能及病理变化的影响

目的探讨吸烟在特发性膜性肾病(idiopathic membranous nephropathy,IMN)患者肾功能减退及病理变化中的作用。方法纳入吉林大学第二医院肾病内科2018年4月至2019年8月经皮肾穿刺活检病理确诊为IMN的患者共60例,收集IMN患者的临床资料、实验室检查资料及病理资料,并调查患者的吸烟状况,分析IMN患者吸烟状态与估算肾小球滤过率(estimated glomerular filtration rate,eGFR)及病理指标的关系。结果单因素相关性分析显示,eGFR与吸烟量呈负相关(r=-0.26,P0.05),肾间质血管总分与吸烟量呈正相关(r_s=0.69,P0.01)。吸烟者肾小管间质纤维化及血管病变更重,多因素二元Logistic回归分析发现吸烟增加IMN患者肾间质纤维化(OR=6.42,P0.05)、血管壁增厚(OR=4.71,P0.05)及血管玻璃样变(OR=7.43,P0.05)的风险。结论吸烟对IMN患者肾功能具有一定的损害作用,是IMN患者肾小管间质纤维化、血管壁增厚及血管玻璃样变的独立危险因素。     

慢性肾脏病3～4期患者营养状态分析

目的以北京市慢性肾脏病3期、4期的患者为研究对象,调查其营养状况,探讨可能存在的营养治疗措施。方法根据估算肾小球滤过率水平选取患者129例。利用改良主观综合性营养评估患者营养状况,与患者的膳食结构进行相关分析。结果患者血清白蛋白≤38g／L的患者占12．4％。随着慢性肾脏病的进展,低白蛋白血症患者的发生率增加。根据患者的改良主观综合性营养评分分成两组,营养较差组占11．6％,该组患者不仅蛋白摄入低,并且优质蛋白所占比例明显较少。结论慢性肾脏病3期和4期的患者营养不良的发生率较低。营养不良与患者的肾功能恶化相关。营养不良的肾脏病患者改善摄入蛋白质的结构,增加优质蛋白的比例有望改善这部分患者的营养状况。     

老年住院患者肾功能情况调查分析

目的 了解老年住院患者肾功能情况及肾功能下降的危险因素。 方法 回顾性分析年龄≥60岁的患者资料,收集肾损伤及相关临床资料,分析患者肾功能情况及相关危险因素。 结果 在1051例患者中,平均eGFR为71.0±24.8 ml·min^-1·(1.73m²)^-1,肾功能下降的发生率为31.1%。60~69岁组、70~79岁组、80~89岁组和90岁以上组eGFR分别为83.4±28.4、72.2±22.9、67.8±24.3、58.8±29.1 ml·min^-1·(1.73m²)^-1,而肾功能下降的发生率分别为12.8%,27.0%,37.8%和51.7%。Logistic回归分析显示,高尿酸血症、蛋白尿、泌尿系肿瘤、贫血、脑卒中、高血压病、肾囊肿、女性、冠心病和年龄是老年人肾功能下降的危险因素。 结论 老年患者肾功能下降的发生率高,且随年龄增大而增高,积极控制相关危险因素将有助于延缓老年患者肾功能下降。     

血糖水平对糖尿病患者肾小球滤过率估算公式的影响

目的 评价糖尿病患者血糖水平对肾小球滤过率（GFR）公式估算结果的影响;比较不同血糖水平Cockcroft-Gault（CG）公式和MDRD公式法估算GFR对诊断肾功能不全的差异。 方法 选取1210例糖尿病患者,同步检测99mTc-GFR（iGFR）、Scr和糖化血红蛋白（HbA1c）。运用CG和MDRD公式计算GFR估计值（eGFRCG、 eGFRMDRD）。依据肾脏病透析预后质量指南（K/DOQI）的建议将糖尿病患者分为iGFR正常组589例[NGFR组,iGFR≥90 ml&#8226;min-1&#8226;(1.73 m2)-1],iGFR轻度下降组[GGFR组,60≤iGFR<90 ml&#8226;min-1&#8226;(1.73 m2)-1]470例,iGFR中度下降组[MGFR组,30≤iGFR<60 ml&#8226;min-1&#8226;(1.73 m2)-1]151例。根据HbA1c的四分位点（7.1%,10.5%）分为4组（<7.1%、7.1%~8.6%、8.7%~10.4%、≥10.5%）,其中HbA1c<7.1%者定义为血糖控制较好组,HbA1c≥10.5%定义为血糖控制差组。采用Spearman相关分析、t检验、Bland-Altman分析、受试者工作特征（ROC）曲线等评估方程的偏离度、准确度,以及血糖对估算结果的影响。 结果 eGFRMDRD在各GFR亚组中均高估GFR;eGFRCG在NGFR组中低估GFR,差异有统计学意义。Bland-Altman分析结果显示,血糖控制较差组的eGFRMDRD的偏差高于血糖控制较好组的eGFRMDRD;血糖控制较差组的eGFRMDRD15%和30%准确性低于血糖控制较好组的eGFRMDRD,差异有统计学意义。血糖控制较差组和较好组间eGFRCG偏差及准确性差异均无统计学意义;而eGFRCG的偏差高于eGFRMDRD,差异有统计学意义。血糖控制良好组CG公式和MDRD公式在诊断肾功能不全患者的ROC曲线下面积差异无统计学意义。血糖控制较差组eGFRMDRD ROC曲线下面积显著大于eGFRCG曲线下面积,差异有统计学意义。 结论 糖尿病患者采用MDRD和CG公式法可导致GFR估计差误。MDRD公式的eGFR估计值受到血糖的影响较大,MDRD公式法高估GFR。MDRD公式在血糖控制较差的患者对肾功能不全患者的估算效应要优于CG公式。     

肾功能不全患者行冠状动脉旁路移植术的长期随访结果

目的 分析估测肾小球滤过率(eGFR)<60 ml/(min·1.73 m~2)的患者冠状动脉旁路移植术后的长期随访结果.方法 回顾性分析1999年1月至2003年9月3371例冠状动脉旁路移植术患者的临床资料,用 Cockcroft-Gault公式计算eGFR,根据eGFR将患者分为肾功能不全组[eGFR<60 ml/(min·1.73 m~2),n=649]肾功能正常组[eGFR>=60 ml/(min·1.73 m~2),n=2722],比较两组患者的近远期随访结果.结果 肾功能不全组的住院病死率和随访4年病死率分别为2.77%和6.81%,明显高于肾功能正常组.肾功能不全组的其他围手术期并发症及远期不良事件发生率也明 显高于肾功能正常组.多因素 COX 回归分析结果显示,eGFR<60 ml/(rain·1.73 m~2)是冠状动脉旁 路移植术后远期死亡的独立危险因素(HR=1.948,95% CI:1.357-2.797,P<0.01).结论 eGFR <60 ml/(min·1.73 m~2)是冠状动脉旁路移植术的独立危险因素.     

血清胱抑素C在肾移植患者肾功能监测中的作用

近年来的研究表明,血清胱抑素C在反映移植肾滤过功能方面优于血清肌酐等传统的检验项目,有助于更及时地发现急性排斥反应或药物性肾中毒。血清胱抑素C测定方法简便、迅速、价格适中,适合临床应用。     

Angiotensin-converting enzyme (ACE) inhibitor therapy after myocardial infarction in relation to left ventricular function

Objective--To investigate to what extent and by what methods clinicians assess left ventricular (LV) function after an acute myocardial infarction (AMI) and how the results of the assessments relate to the use of angiotensin-converting enzyme (ACE) inhibitors; furthermore, to explore which main indications caused the clinicians to initiate ACE inhibitor therapy. Design--From 16 hospitals we drew a sample of patients who were discharged with the diagnosis of AMI during a 3-month period in 1999/2000. Physicians in each hospital obtained the observed rate of use of cardiovascular drugs at discharge and also information on ejection fraction (EF) measurements. The results of the EF recordings were classified into three categories: &gt;0.50, 0.40-0.50 and &lt;0.40. The clinicians' main indications for drug use were reported. Results--Among 767 patients discharged alive, EF was measured in 409 (53%), by echocardiography in 53% and by radionuclide ventriculography in 47%. Of the 409 patients 227 (55%) had EF &gt;0.50,?95 (24%) EF 0.40-0.50 and 87 (21%) EF &lt;0.40. Adjusted odds ratio for ACE inhibitor therapy being initiated during the AMI was 13.5 for those with EF &lt;0.40 compared with those with EF &gt;0.50. The main indication for starting ACE inhibitor therapy was heart failure (50%) followed by secondary prevention (42%). Conclusion--Measuring EF appears to be an important tool in the evaluation of AMI patients prior to discharge from hospital. Initiation of ACE inhibitor therapy related strongly to the results of the assessments.     

间质纤维化评分在不同病理类型所致的肾病综合征患者中的临床意义及其与肾脏预后的关系

目的 分析间质纤维化评分在不同病理类型所致的肾病综合征患者中的临床意义及其与肾脏预后的关系.方法 选取2016年5月至2018年9月本院收治的298例肾病综合征患者,包括经活检证实的微小病变肾病(MCD)患者92例、局灶节段性肾小球硬化(FSGS)患者114例、膜性肾病(MN)患者56例和IgA肾病(IgAN)患者36...     

运用AMI-RISK评分指导急性心肌梗死患者早期活动

目的提高急性心肌梗死(AMI)患者住院后活动效果和安全性。方法将213例AMI患者随机分为两组,对照组101例按常规活动护理,观察组112例采用AMI患者活动护理分级评估量表(AMI-RISK)评分,根据评分指导患者活动。结果观察组卧床时间,住院时间显著短于对照组,活动受限相关并发症发生率显著低于对照组(P0.05,P0.01)。结论在AMI-RISK评分指导下对AMI患者实施活动护理可缩短卧床时间和住院时间,减少活动受限相关并发症的发生。     

急性心肌梗死患者活动护理分级量表的设计与应用

目的 建立急性心肌梗死患者风险(AMI-RISK)评分表,用于评估和指导急性心肌梗死(AMI)患者活动及护理等级.方法 根据课题组先期研制的AMI患者早期活动评估指标的评分制定AMI-RISK评分表,评估并计算其总分Q,总分Q≥4分其活动及护理等级为A,3分为B,2分为C,1分为D,0分为E.对60例AMI患者根据Q值指导活动并实施相应的活动护理.结果 60例患者中有3例出现活动后胸闷而降低一个活动等级,其余57例患者无异常.患者从入院到开始下床活动时间20～216(77.4±54.4)h.住院时间4～23(10.6±3.4)d.结论 建立的AMI早期活动护理分级量表,有利于临床根据个体特点评估活动风险,给予患者相应等级的活动与护理,具有较好的适用性和安全性.     

异丙酚对急性心肌梗死大鼠心脏功能的影响

目的 观察异丙酚对急性心肌梗死大鼠血液动力学影响的量-效关系以及心肌梗死范围和心肌超微结构的变化。方法 将急性心肌梗死模型的大鼠随机分为5组（n=8）,对照组（Ⅰ）,其余大鼠分别持续静脉输注30（Ⅱ）、45（Ⅲ）、60（Ⅳ）、75（Ⅴ）mg·kg-1·h-1异丙酚30min。测定输注异丙酚30min血药浓度,观察血液动力学、心肌梗死范围和心肌超微结构的变化。结果 血药浓度为（3.4±0.9）～（12.9±2.4）μg/ml时,平均动脉压（MAP）、心率（HR）、左室收缩压（LVSP）、左室内压力变化最大速率（±dp/dtmax）、心肌耗氧指数（MOCI）均呈剂量依赖性下降（P<0.05）,左心室舒张末压（LVEDP）无明显变化（P>0.05）,心肌梗死面积为23.7％～29.2％（P>0.05）,心肌超微结构无显著性差异。结论 在血药浓度（3.4±0.9）～（12.9±2.4）μg/ml范围内,异丙酚对血液动力学及心收缩功能呈剂量依赖性抑制,对心肌梗死范围和心肌细胞超微结构无明显影响。     

帕瑞昔布钠对急性心肌梗死大鼠心功能的影响

目的 评价帕瑞昔布钠对急性心肌梗死大鼠心功能的影响.方法 成年雄性SD大鼠24只,体重230～250 g,随机分为3组(n=8):假手术组(S组)、急性心肌梗死组(AMI组)和帕瑞昔布钠组(P组).AMI组和P组采用结扎左冠状动脉前降支的方法制备大鼠急性心肌梗死模型,S组冠状动脉穿线但不结扎;24 h后P组腹腔注射帕瑞昔布钠8 mg/kg,1次/d,连续3 d,AMI组用生理盐水替代.术后第4天测定并记录左心室收缩压(LVSP)、左心室舒张末期压(LVEDP)、左心室收缩压最大上升速率(+dp/dtmax)和左心室收缩压最大下降速率(-dp/dtmax);采集颈总动脉血样3 ml,采用放射免疫法测定血浆血栓素A2(TXA2)和前列腺素I2(PGI2)的浓度,并计算PGI2/TXA2;采血后取左心室心肌组织,测定梗死面积,计算心肌梗死体积.结果 与S组比较,AMI组和P组LVSP、±dp/dtmax、血浆PGI2浓度和PGI2/TXA2降低,LVEDP和血浆TXA2浓度升高(P＜0.05).与AMI组比较,P组LVSP、±dp/dtmax、血浆PGI2浓度和PGI2/TXA2升高,LVEDP和血浆TXA2浓度降低(P＜0.05).AMI组和P组心肌梗死体积比较差异无统计学意义(P＞0.05).结论 帕瑞昔布钠可改善急性心肌梗死大鼠左心室功能,其机制与调节PGI2/TXA2相对平衡有关.     

Perioperative myocardial infarction in patients undergoing myocardial revascularization surgery

Introduction

Perioperative myocardial infarction adversely affects the prognosis of patients undergoing coronary artery bypass graft and its diagnosis was hampered by numerous difficulties, because the pathophysiology is different from the traditional instability atherosclerotic and the clinical difficulty to be characterized.

Objective

To identify the frequency of perioperative myocardial infarction and its outcome in patients undergoing coronary artery bypass graft.

Methods

Retrospective cohort study performed in a tertiary hospital specialized in cardiology, from May 01, 2011 to April 30, 2012, which included all records containing coronary artery bypass graft records. To confirm the diagnosis of perioperative myocardial infarction criteria, the Third Universal Definition of Myocardial Infarction was used.

Results

We analyzed 116 cases. Perioperative myocardial infarction was diagnosed in 28 patients (24.1%). Number of grafts and use and cardiopulmonary bypass time were associated with this diagnosis and the mean age was significantly higher in this group. The diagnostic criteria elevated troponin I, which was positive in 99.1% of cases regardless of diagnosis of perioperative myocardial infarction. No significant difference was found between length of hospital stay and intensive care unit in patients with and without this complication, however patients with perioperative myocardial infarction progressed with worse left ventricular function and more death cases.

Conclusion

The frequency of perioperative myocardial infarction found in this study was considered high and as a consequence the same observed average higher troponin I, more cases of worsening left ventricular function and death.     

Effect of acute kidney injury on short-and long-term mortality of patients with acute myocardial infarction

Objective To evaluate the role of acute kidney injury (AKI) in predicting the early (30-day) and late (30-day to 5-year) mortality of acute myocardial infarction (AMI) patients during hospitalization. Methods A total of 1371 adult patients diagnosed with AMI in the First People's Hospital of Changzhou from January 2008 to December 2012 were analyzed retrospectively with collecting their relevant clinical data from the hospital's database. AKI was categorized according to the 2012 KDIGO AKI criteria. To compare between death group and non-death group in AMI patients during 30-day and 30-day to 5-year. Different AKI stages of patients were compared, and their all-cause mortality were analyzed by Kaplan-Meier. Using multivariate COX regression analysis with two models to assess the factors for AMI patients in 30-day to 5-year. Results The prevalence of AKI after AMI in death group was higher than that in non-death group (the 30-day prevalence was 72.7% vs 27.4%, P＜0.001; the 5-year prevalence was 36.3% vs 26.2%, P=0.013). In both early (30-day) and late (30-day to 5-year) follow up, the KDIGO grading distribution of AKI was different between death group and non-death group (P＜0.001 in 30-day follow up and P=0.002 in 30-day to 5-year follow up). Among the 1371 AMI patients,410 (29.9%) developed AKI during the hospital stay. The 30-day and 30-day to 5-year mortality rates were 5.6% (77/1371) and 11.3% (146/1294) respectively. All-cause mortality and cardiovascular mortality were significantly higher in patients with AKI-Ⅰstage, AKI-Ⅱ stage and AKI-Ⅲ stage than those with non-AKI (all P＜0.001), especially in patients with AKI-Ⅲ stage. Further stroke history (HR=3.122, P=0.012), AKI severity (AKI-Ⅰstage HR=3.034, P=0.028; AKI-Ⅱ stage HR=7.832, P＜0.001; AKI -Ⅲ stage HR=9.919, P＜0.001), and β-blocker therapy (HR=0.591, P=0.040) were independent predictors of 30-day mortality, while aging (HR=1.061, P＜0.001), albumin (HR=0.943, P=0.023), AKI -Ⅲ stage (HR=3.944, P=0.007), β-blocker therapy (HR=0.660, P=0.041) and percutaneous coronary intervention (HR=0.256, P＜0.001) were independent predictors of 30-day to 5-year mortality. Both at early (30-day) and late (30-day to 5-year) follow-up, AKI with or without baseline renal dysfunction were independent predictors of death in patients with AMI (all P＜0.05). Conclusions AKI strongly correlated with short- and long-term all-cause mortality of AMI patients, regardless of the baseline renal impairment. Specifically, the more severe AKI, the higher short-term mortality AMI patients have.     

Early vectorcardiographic monitoring provides prognostic information in patients with ST-elevation myocardial infarction

Objective--To evaluate the prognostic value of specified vectorcardiographic data obtained during the first hours of ST-elevation myocardial infarction for cardiac outcomes up to 5 years. Design--Three hundred and five patients with ST-elevation myocardial infarction and chest pain for less than 12?h were monitored with continuous vectorcardiography. Results--All patients had follow-up for at least 1 year. The mortality was 5.9% at 30 days and 10.8% at 1 year. The estimated 5-year mortality was 24%. A total of 7.9% had recurrent infarction at 30 days and 11.2% at 1 year. Recurrent infarction or death occurred in 12.1% at 30 days and in 19.7% at 1 year. The presence of ST-VM[Formula: See Text]?≥?125?μV was highly predictive of the combined endpoint death or recurrent infarction at 1 year, OR 2.69 (95% CI 1.39-5.23). Multivariate analysis showed that age ≥75 years, anterior myocardial infarction, and the presence of ST-VM[Formula: See Text]?≥?125?μV, were independently associated with increased risk of recurrent infarction or death at 1 year and with death at 5-year follow-up. A start value of ST-VM ≤?100?μV identified a group of patients with low risk of death or re-infarction within 1 year. Conclusion--Continuous vectorcardiography during the first hours after thrombolytic treatment of patients with ST-elevation myocardial infarction provides important prognostic information. A new vectorcardiographic variable, ST-VM[Formula: See Text], identifies a group of patients with increased risk of recurrent infarction or death. As well, patients with low risk of recurrent infarction or death were identified by low start values of ST-VM.