急性冠状动脉综合征非ST段抬高患者心血管危险因素及其影像学特征

目的：分析比较非ST段抬高的急性冠状动脉综合征与ST段抬高的急性心肌梗死患者的心血管危险因素和影像学特征。 方法：选择2003-01／2004-04在南方医科大学南方医院心内科住院并 接受冠脉造影的冠心病患者，按照2002年美国心脏病学学院／美国心脏协会不稳定型心绞痛和非ST段抬高心肌梗死治疗指南及2000年中华医学会心血管病学分会的不稳定性心绞痛诊断和治疗建议进行诊断分类。非ST段抬高的急性冠状动脉综合征患者33例(非ST段抬高组)，男30例，女3例。ST段抬高的急性心肌梗死患者33例(ST段抬高组)，男27例，女6例。对两组患者的心血管危险因素和影像学特征进行对比统计分析。 结果：进入结果分析非ST段抬高急性冠状动脉综合征患者33例，ST段抬高急性心肌梗死患者33例。非ST段抬高组与ST段抬高组具有相同程度的冠心病危险因素年龄、血脂紊乱、高血压、肥胖、合并糖尿病、有吸烟史、有早发冠心病家族史(P>0．05)。非ST段抬高组患者具有2个以上心血管危险因素，其病变血管数与ST段抬高维相似；冠状动脉狭窄程度重于ST段抬高组[狭窄程度<50％：8，3例；50％～74％：9，9例；75％～99％：53，43例；100％：1，20例，Z=3．45，P=0．001]，但>75％以上严重的狭窄病变占总病变的76％。严重狭窄病变形态差于ST段抬高组(Z=3．23，P=0．001)。 结论：非ST段抬高的急性冠状动脉综合征与ST段抬高的心肌梗死患者具有相似的危险因素；ST段抬高的急性心肌梗死患者冠状动脉狭窄更严重，而且较严重的病变形态多于非ST段抬高的急性冠脉综合征患者。     

非ST段抬高急性冠脉综合征介入治疗的系统评价

目的系统评价早期介入治疗对非ST段抬高急性冠脉综合征的有效性和安全性。方法计算机检索Cochrane图书馆（2009年第4期）、MEDLINE（1966～2009.9）、EMbase（1974～2009.9）、中国生物医学文献数据库（1989～2009.9）、中国期刊全文数据库（1997～2009.9）和万方数据库（1989～2009.9）,收集介入治疗非ST段抬高急性冠脉综合征的随机对照试验,由两名评价员按照纳入与排除标准选择文献、评价质量和提取资料,对符合纳入标准的研究用RevMan 5.0软件进Meta分析。结果共纳入7个随机对照试验,11394例患者。Meta分析结果显示：与保守治疗相比,早期介入治疗能降低非ST段抬高急性冠脉综合征6个月时的全因病死率[RR=0.75,95%CI（0.61,0.92）,P=0.007];随访1年时,这种优势有下降趋势[RR=0.88,95%CI（0.65,1.18）,P=0.38];早期介入治疗能降低6个月时致死性或非致死性心梗发生率[RR=0.74,95%CI（0.63,0.87）,P=0.0003];早期介入治疗能显著降低因心绞痛再入院率[RR=0.66,95%CI（0.61,0.73）,P〈0.00001];6个月时出血发生率早期介入组较高[RR=1.28,95%CI（0.91,1.80）,P=0.15],但差异无统计学意义,随访1年时早期介入组出血发生率高[RR=2.22,95%CI（1.55,3.17）,P〈0.0001];早期介入组与保守治疗组相比,发生介入相关的心肌梗死发生率更高[RR=2.07,95%CI（1.57,2.72）,P〈0.00001];肌钙蛋白阳性组早期介入治疗的联合终点事件发生率明显降低[RR=0.60,95%CI（0.43,0.82）,P=0.002]。结论早期介入治疗能降低非ST段抬高急性冠脉综合征的全因病死率、心梗发生率和因心绞痛再入院率,肌钙蛋白阳性患者更能从早期介入治疗中获益。早期介入治疗发生出血和介入相关的心肌梗死等并发症的风险也比保守治疗要高,故临床决策时应充分权衡利弊。     

不稳定性心绞痛及非ST段抬高急性心肌梗死早期介入及药物治疗的比较

目的：比较不稳定性心绞痛和非ST段抬高心肌梗死患者早期应用经皮冠状动脉介入治疗和药物治疗的疗效。方法：选择我院心内科住院的患者共136例，分为早期药物保守治疗组和介入治疗组。随访患者1～24个月的心绞痛复发率、再次入院率和再次介入治疗率或血管搭桥术，以及心源性死亡和（或）急性心肌梗死发生率。结果：介入治疗组心源性死亡和（或）急性心肌梗死发生率较药物治疗组显著降低，介入治疗组在心绞痛复发率、再住院率方面同药物保守组比较均显著降低（P均〈O．001）。结论：早期经皮冠状动脉介入治疗能显著改善不稳定性心绞痛和非ST段抬高心肌梗死患者的预后。     

急性心肌梗死后运动诱发ST段抬高的临床意义

运动诱发ST段降低的临床意义已很明确，但运动诱发ST段抬高的临床意义还不十分清楚。国内关于这方面的报道也不多见。本文旨在探讨心肌梗死后运动诱发ST段抬高的临床意义。1资料与方法l．1病例选择所有病例均选自1992年7月～1997年7月间入院的首次急性心肌梗死（AMI）患者，共48例。男37例，女11例；年龄41～76岁，平均56±17岁。频发胸痛、持续性ST段降低＞1．0mm、合并束支传导阻滞及其他影响ST段的因素者，以及不能进行运动试验者均不包括在内。所有病例根据蹬车试验，并根据有无ST段抬高，分为两组：ST段抬高组，27例：无ST段抬…     

急性冠状动脉综合征非ST段抬高患者心血管危险因素及其影像学特征

目的：分析比较非ST段抬高的急性冠状动脉综合征与ST段抬高的急性心肌梗死患者的心血管危险因素和影像学特征.方法：选择2003-01/2004-04在南方医科大学南方医院心内科住院并接受冠脉造影的冠心病患者,按照2002年美国心脏病学学院/美国心脏协会不稳定型心绞痛和非ST段抬高心肌梗死治疗指南及2000年中华医学会心血管病学分会的不稳定性心绞痛诊断和治疗建议进行诊断分类.非ST段抬高的急性冠状动脉综合征患者33例（非ST段抬高组）,男30例,女3例.ST段抬高的急性心肌梗死患者33例（ST段抬高组）,男27例,女6例.对两组患者的心血管危险因素和影像学特征进行对比统计分析.结果：进入结果分析非ST段抬高急性冠状动脉综合征患者33例,ST段抬高急性心肌梗死患者33例.非ST段抬高组与ST段抬高组具有相同程度的冠心病危险因素年龄、血脂紊乱、高血压、肥胖、合并糖尿病、有吸烟史、有早发冠心病家族史（P＞0.05）.非ST段抬高组患者具有2个以上心血管危险因素,其病变血管数与ST段抬高组相似;冠状动脉狭窄程度重于ST段抬高组[狭窄程度＜50%：8,3例;50%～74%：9,9例;75%～99%：53,43例;100%：1,20例,Z=3.45,P=0.001],但＞75%以上严重的狭窄病变占总病变的76%.严重狭窄病变形态差于ST段抬高组（Z=3.23,P=0.001）.结论：非ST段抬高的急性冠状动脉综合征与ST段抬高的心肌梗死患者具有相似的危险因素;ST段抬高的急性心肌梗死患者冠状动脉狭窄更严重,而且较严重的病变形态多于非ST段抬高的急性冠脉综合征患者.     

急性前壁心肌梗死患者aVR导联ST段抬高的预后价值探讨

目的探讨12导联体表心电图aVR导联ST段抬高对急性前壁心肌梗死预后的预测价值。方法对2003年1月～2007年3月首次因急性前壁心肌梗死入院患者44例，根据入院后12导联体表心电图aVR导联ST段的偏离情况将患者分为ST段抬高组15例和ST段无抬高组29例。结果ST段抬高组发生心脏事件6例（占40．00％），ST段无抬高组发生心脏事件4例（占13．79％），两组间差异有统计学意义（P〈0．05）。结论观测12导联体表心电图aVR导联ST段的抬高对预测急性前壁心肌梗死的预后有着重要的意义，值得重视。     

替罗非班联合急诊介入治疗急性非ST段抬高心肌梗死两年随访研究

目的探讨替罗非班联合急诊介入治疗急性非ST段抬高心肌梗死2年的临床疗效。方法由"生命网"筛选的依从性较好的112例急性非ST段抬高心肌梗死患者纳入研究,其中2007年1月至2008年1月的54例已行急诊介入治疗急性非ST段抬高心肌梗死患者作对照组,2008年1月至2009年1月58例确诊急性非ST段抬高心肌梗死患者采用替罗非班联合急诊介入治疗作治疗组,比较接受两种方法治疗的患者在术后2年内的近期及远期临床疗效。结果分析对照组和治疗组的临床疗效:对照组和治疗组术后恢复血流TIM I 3级比例为90.7%vs.96.6%,P<0.05;对照组和治疗组术后12周心肌灌注显像(ECT)显示存活心肌面积为(80±9.4)%vs.(88±8.3)%,P<0.05;对照组和治疗组术后、术后半年、2年心脏彩色超声左心室射血分数均有所增加,半年增加情况对比为(3±2.6)%vs.(5±6.5)%,2年增加情况对比为(2±4.6)%vs.(5±7.3)%;对照组和治疗组2年心血管死亡事件比例为7.4%vs.3.4%,P<0.05。结论替罗非班联合急诊介入治疗急性非ST段抬高心肌梗死可以改善心肌微循环、减少心肌坏死、保护心脏机能,...     

心电图aVR导联ST段抬高对急性非ST段抬高型心肌梗死临床预后的判断

目的:通过对心电图aVR导联ST段抬高的临床分析,判断急性非ST段抬高型心肌梗死患者冠脉病变程度以及心功能的状况,从而对患者的短期临床预后作出初步的评估。方法:选取2004年3月至2007年6月在我院心脏科住院的急性非ST段抬高型心肌梗死患者120例,根据患者入院时心电图aVR导联ST段改变情况将患者分为aVR导联ST段抬高>0.1mV、aVR导联ST段抬高0.05～0.1mV、aVR导联无ST段抬高3组。结果:aVR导联ST段抬高>0.1mV的患者急性期(1个月)以及随访1年后的病死率明显高于aVR导联无ST段抬高或aVR导联ST段抬高0.05～0.1mV者,且aVR导联ST段抬高程度与患者的临床预后有关。结论:aVR导联ST段抬高的急性非ST段抬高型心肌梗死患者在急性期以及随访1年内病死率高于aVR导联ST段不抬高或aVR导联ST段抬高幅度较低者,且往往血管病变较重,预后亦较差。尽早冠脉介入治疗是有必要的。     

非ST段抬高急性冠状动脉综合征患者的介入治疗

目的：分析急性冠脉综合征患者非ST段抬高时行经皮冠状动脉介入治疗术(PCI)的有效性和安全性。方法：从2001年1月至2003年10月在我院住院的72例非ST段抬高急性冠脉综合征病人，包括不稳定型心绞痛病人UAP)48例，非ST抬高急性心肌梗死(NSTEMI)病人24例，除常规内科治疗外，接受冠状动脉造影及介入治疗(PTCA和支架植入术)。造影提示单支血管病变31例(43．1％)，双支血管病变25例(34．7％)，三支血管病变16例(22．2％)，分别行PTCA和支架植入术。结果：介入治疗的成功率97．2％(70／72)，失败的两例患者主要是导丝不能通过闭塞病变所致。在70例患者中，共植入支架91枚。随访至术后30d，无症状或症状明显缓解的61例；2例发生ST段抬高急性心肌梗死；4例多支血管病变患者再次行介入治疗；3例患者转外科行CABG术；2例患者死亡。结论：经皮冠状动脉介入治疗是非ST段抬高急性冠脉综合征的有效和安全的治疗方法。     

急性ST段抬高型心肌梗死患者行急诊冠状动脉介入治疗对心功能的影响

目的研究急性ST段抬高型心肌梗死患者行急诊冠状动脉介入治疗对心功能的影响。方法选取我院2016年3~12月收治的急性ST段抬高型心肌梗死患者70例,分为择期手术组和急诊手术组35例。择期手术组行择期介入手术治疗,急诊手术组行急诊冠状动脉介入治疗。比较两组患者干预效果及施行治疗前和施行治疗后心功能指标差异。结果急诊手术组患者急性ST段抬高型心肌梗死干预效果显著高于择期手术组,差异有统计学意义(P0.05);治疗前两组心功能指标比较无显著差异(P0.05);治疗后,急诊手术组心功能指标改善幅度更大,与对照组比较,差异有统计学意义(P0.05)。结论急性ST段抬高型心肌梗死患者行急诊冠状动脉介入治疗对心功能有明显改善作用,有助于改善患者预后,值得推广。     

不同时期急性心肌梗死的临床特点分析

目的 分析我院心脏中心8年来收治5720例急性心肌梗死(AMI)患者的临床特点和院内死亡原因.方法 2002年1月1日至2009年12月31日期间我院心脏中心收治AMI患者5720例.根据年龄分为≤45岁组、46～75岁组和＞75岁组,统计分析其发病率、死因、是否接受PCI介入治疗及接受介入治疗后的死亡情况以及性别对死因的影响.结果 2002-2009年不同年龄组AMI发病率男性均高于女性,＞75岁组女性发病率显著升高,但仍低于男性.所有AMI患者接受介入治疗的比例明显升高,接受介入治疗患者每年病死率明显下降.死亡原因前三位是急性心力衰竭、心源性休克及急性心力衰竭合并心源性休克,且在女性和＞75岁患者急性心力衰竭导致的死亡明显增加.结论 我院AMI住院人数逐年增加,接受介入治疗能降低病死率,＞75岁老年人血运重建治疗仍然是可行及安全的.

Abstract：

Objective The study aimed to analyze the clinical features and the causes of hospital death among the 5720 acute myocardial infarction(AMI)patients from Cardiology Center,Beijing Chao-Yang Hospital during the last 8 years. Methods A total of 5720 AMI patients received treatment in the Cardiology Center from January 1st ,2002 to December 31th ,2009 were retrospectively reviewed. All patients were classified according to age into 3 groups of ≤45,46 -75,and ＞ 75 years old. The morbidity,cause of death ,whether they had the PCI therapy,mortality after PCI and the impact of gender on the cause of death were observed respectively. Results The morbidity rate of male was significantly higher than female in all three groups,and the study also found that the morbidity rate of female was significantly higher in the group of ＞ 75 years old,which however was still lower than that of male. The AMI patients were more likely to accept PCI therapy,which could significantly reduce the mortality rate. The top 3 causes of death included acute heart failure(AHF),cardiogenic shock(CGS)and AHF combined with CGS. In addition,AHF caused significantly more death in female and older(＞ 75 years old)patients. Conclusions The morbidity rate of AMI patients in Beijing Chao-Yang Hospital increased year by year. And PCI therapy could reduce the mortality rate of all groups. Revascularization treatment seems to be feasible and safe for the patients older than 75 years old.     

急性心肌梗死“墓碑样”ST段改变的临床意义

目的：探讨急性心肌梗死（AMI）时,"墓碑样"ST段改变的临床意义和预后。方法：48例AMI患者,根据ST段形态分为墓碑样组（n=11）和对照组（n=37）。比较两组间ST段上抬高度、ST段抬高导联数、CK峰值、QT离散度、心脏严重并发症例数和死亡率以及广泛心肌梗死（ST段抬高导联数＞5个）的发生例数。结果：除广泛心肌梗死的例数二组之间比较无差异（P＞0.05）外,墓碑样组均大于对照组,差异显著（P＜0.05）。墓碑样组室性心律失常的发生率和由此引起的死亡数亦大于对照组（P＜0．05）。结论：有"墓碑样"ST段改变者预后较差,与心肌梗死范围相比,心肌缺血损伤程度较重可能是其预后不良的更重要原因。     

The initial electrocardiogram in patients seen by a mobile coronary care unit

The advent of thrombolytic therapy for patients with suspected acute myocardial infarction has highlighted the importance of the initial electrocardiogram (ECG) in decision making. Thus we analysed the initial ECGs of 94 consecutive cases with suspected myocardial infarction who were seen within six hours after the onset of chest pain by a mobile coronary care unit. The study included 91 patients (three patients admitted twice) (61 male), aged 27-83 years (mean 60.5). Median time from onset of chest pain to arrival of the mobile coronary care unit was 75 minutes (range 15-345), and mean mobile coronary care unit response time was 12.3 +/- 7 (SD) minutes (range 5-45). The majority of cases (65 of 94, 69.1 per cent) were seen within two hours of the onset of symptoms. A final diagnosis of myocardial infarction was made in 48 of 94 (51.1 per cent) cases; 38 had unstable angina and eight other diagnoses. Of the 48 with myocardial infarction the initial ECG showed ST segment elevation in 37, ST depression and or T wave inversion in six, Q waves only in three and left bundle branch block in two. No patient with an initially normal ECG had a myocardial infarction. Thrombolytic therapy was given out of hospital to 33 of 38 patients with ST segment elevation. In seven patients with ST elevation (median delay time to intensive care 60 minutes), rapid resolution of ST segment elevation occurred following thrombolytic therapy and there was no significant elevation of cardiac enzymes, suggesting that the infarct had been aborted.(ABSTRACT TRUNCATED AT 250 WORDS)     

Cause of ST segment abnormality in ED chest pain patients

The objective of this study was to determine the electrocardiographic diagnoses of chest pain patients with ST segment elevation (STE) on the 12-lead electrocardiogram (ECG). This study was a retrospective ECG review of adult chest pain patients in a university hospital emergency department (ED) over a 3-month period (January 1, 1996 to March 31, 1996). STE was determined if the ST segment was elevated >/=1 mm in the limb leads and >/=2 mm in the precordial leads in at least two anatomically contiguous leads. Results showed 902 patients who met entry criteria and of whom 202 (22.4%) had STE. Thirty-one (15%) patients had STE acute myocardial infarction (AMI) as the final hospital diagnosis which caused the STE; 171 (85%) patients with STE had non-AMI diagnosis responsible for the ST segment elevation, including left ventricular hypertrophy (LVH) 51 (25%), left bundle branch block (LBBB) 31 (15%), benign early repolarization (BER) 25 (12%), right bundle branch block 10 (5%), nonspecific bundle branch block 10 (5%), left ventricular aneurysm 5 (3%), acute pericarditis 2 (1%), ventricular paced rhythm 2 (1%), and undefined ST segment elevation 35 (17%). Forty-four patients had AMI as the final diagnosis of whom 31 showed STE on presentation to the ED. In 2 of 31 (6%) cases of STE AMI, the ST segment waveform was atypical for acute infarction. We concluded that AMI is not the most common cause of STE in ED chest pain patients. LVH is most often responsible for electrocardiographic STE followed by AMI and LBBB which occur at equal frequencies.     

自动功能成像评估急性心肌梗死患者左心室功能及梗死范围

目的 应用二维斑点追踪自动功能成像(AFI)技术评价急性心肌梗死(AMI)患者的左心室功能,及其与AMI常规心肌标志物肌钙蛋白T(cTnT)以及心电图ST段抬高的相关性,探讨AFI的临床应用价值。方法 获取46例首发AMI患者（心肌梗死组）和30例年龄性别相关受检者（对照组）的二维超声图像,同时记录12导联心电图和AMI患者入院24 h的cTnT值,应用AFI技术实时获取左室收缩峰值纵向应变(LPSS)及其牛眼图。结果 与对照组相比,心肌梗死组的左室射血分数(LVEF)、LPSS明显减低(P ＜0.001),ST段明显抬高(P＜0.001);整体LPSS与梗死节段LPSS均与LVEF呈负相关,整体LPSS与LVEF的相关性较高（r=-0.660）;整体LPSS与梗死节段LPSS均与cTnT呈正相关(P＜0.001),LVEF与cTnT呈负相关(P=0.002),梗死节段LPSS与cTnT的相关性较高(r=0.598);整体LPSS与梗死节段LPSS均与ST段抬高呈正相关(P＜0.05)。结论整体LPSS能准确评价AMI患者的左室收缩功能,梗死节段LPSS能准确评价AMI患者的梗死受累范围和程度。AFI作为简易快捷的程序性诊断工具可为临床评价AMI提供有价值的信息。     

Electrocardiographic ST segment elevation: a comparison of AMI and non-AMI ECG syndromes

Chest pain (CP) patients presenting to the ED may manifest electrocardiographic ST segment elevation (STE). AMI (acute myocardial infarction) is a less frequent cause of such abnormality and one of many patterns responsible for ST segment elevation in ED CP patients. We performed a retrospective comparative review of the electrocardiographic features of various STE syndromes, focusing on differences between AMI and non-AMI syndromes. The electrocardiograms (ECGs) of consecutive ED adult CP patients (with 3 serial troponin I determinations) were interpreted by 3 attending emergency physicians. These ECGs with STE represented the study population used for analysis. Various electrocardiographic features such as STE, ST segment depression (STD), STE morphology, anatomic distribution of STE, and the number of leads with STE were recorded; derived values such as total STE, total ST segment deviation, and average STE per lead were calculated. Interobserver reliability concerning STE morphology was determined. AMI was diagnosed by abnormal serum troponin I values (>0.1 mg/dL) followed by a rise and fall of the serum marker; STE diagnoses of non-AMI causes were determined by medical record review. Five hundred ninety-nine CP patients were entered in the study with 212 (35%) individuals showing STE, 55 (26%) with electrocardiographic AMI and 157 (74%) with non-AMI electrocardiographic syndromes. Anatomic location within the AMI group included 32 inferior and inferior variants, 18 anterior and anterior variants, and 5 lateral; non-AMI anatomic locations included 56 inferior and inferior variants, 98 anterior and anterior variants, and 3 lateral; anterior STE occurred significantly more often in non-AMI syndromes. Total STE was 15.3 mm in AMI patients and 7.4 mm in non-AMI patients (P =.0004). The number of leads with STE was not significantly different between the two groups, 3.4 mm in AMI and 4.1 in non-AMI syndromes. ST segment elevation per lead was not significantly different in the 2 groups, 4.4 mm in AMI versus 1.8 mm in non-AMI syndromes. Total ST segment deviation (sum of STE and STD) was significantly greater in AMI syndromes, 17.8 mm in AMI compared with 10.5 mm in non-AMI syndromes (P =.00009). The presence of STD occurred at statistically similar rates in both groups. The morphology of the STE occurred in significantly different rates between AMI and non-AMI patterns, concave more often in non-AMI patterns (P <.00001) and nonconcave more often in AMI (P <.00001). Non-AMI causes of STE account for the majority of electrocardiographic syndromes encountered in ED chest pain patients. These findings alone are not adequate to determine the electrocardiographic cause of the ST segment elevation in chest pain patients. When determining AMI versus non-AMI with the ECG, these various findings should be used in the consideration of the overall clinical picture (history, examination, and electrocardiogram) in chest pain patients with ST segment elevation.     

Reciprocal ST segment depression: impact on the electrocardiographic diagnosis of ST segment elevation acute myocardial infarction.

Acute myocardial infarction (AMI) is one of many causes of electrocardiographic ST segment elevation (STE) in ED chest pain (CP) patients; at times, the electrocardiographic diagnosis may be difficult. Coexistent ST segment depression has been reported to assist in the differentiation of non-infarction causes of STE from AMI-related ST segment elevation. The objective was to determine the effect of AMI diagnosis on the presence of STD among ED CP patients with electrocardiographic STE. Adult CP patients with electrocardiographic STE in at least 2 anatomically distributed leads were reviewed for the presence or absence of ST segment depression in at least 1 lead and separated into 2 groups, both with and without ST segment depression. A comparison of the 2 groups was performed in 2 approaches: all STE patients and then only with STE patients who lacked confounding electrocardiographic pattern (bundle branch block [BBB], left ventricular hypertrophy [LVH], or right ventricular paced rhythm [VPR]). All patients in the study underwent prolonged observation in the ED (at least 8 hours) with 3 serial troponin T determinations and 3 electrocardiograms (ECG). AMI was diagnosed by abnormal serum troponin T values (>0.1 mg/dL); electrocardiographic STE diagnoses of non-AMI causes were determined by medical record review. There were 171 CP patients with STE were entered in the study with 112 (65.5%) individuals show ST segment depression. When considering all study patients, ST segment depression was present at statistically equal rates in AMI and non-AMI situations (P = NS). The sensitivity, specificity, positive predictive value, and negative predictive value for the electrocardiographic diagnosis of AMI were 63%, 34%, 30%, and 67%, respectively. Patients with confounding patterns (LVH 46, BBB 19, and VPR 6) were removed from the analysis group, leaving 100 patients for analysis; 38 of these patients had ST segment depression. When considering this group of study patients, ST segment depression was present significantly more often in AMI patients (P <.0001). The sensitivity, specificity, positive predictive value, and negative predictive value for the electrocardiographic diagnosis of AMI were 69%, 93%, 93%, and 71%, respectively. Clinical diagnoses were as follows: 56 AMI, 50 USAP, and 65 noncoronary syndrome. When all CP patients with electrocardiographic STE are considered, the presence of ST segment depression is not helpful in distinguishing AMI from non-AMI. If one considers only patterns which lack electrocardiographic ST segment depression caused by altered intraventricular conduction, the presence of ST segment depression strongly suggests the diagnosis of AMI. In these cases, reciprocal ST segment depression is of considerable value in establishing the electrocardiographic diagnosis of STE AMI.     

Effects of receipt of chronic statin therapy before the onset of acute myocardial infarction: a retrospective study in patients undergoing primary percutaneous coronary intervention

BACKGROUND: Studies have reported an association between receipt of statin therapy and a reduction in complications after elective percutaneous coronary intervention (PCI). However, there are limited data on the effects of chronic statin therapy before the occurrence of an acute myocardial infarction (AMI). OBJECTIVE: This study investigated whether administration of chronic statin therapy before AMI was associated with a reduction in reperfusion injury in AMI patients undergoing PCI. METHODS: This was a retrospective study of consecutive patients with a first AMI who underwent successful reperfusion therapy with PCI within 24 hours after the onset of AMI between April 1998 and October 2003. Patients were stratified according to whether they had or had not been receiving chronic statin therapy for > or = 1 month before the onset of AMI. The following end points were compared after PCI: electrocardiographic resolution of ST segment elevation, defined as a reduction of > or = 50% from the initial value; achievement of Thrombolysis in Myocardial Infarction (TIMI) grade 3 flow; corrected TIMI frame count (cTFC); maximum serum creatine kinase (CK) level; and the type and frequency of ventricular arrhythmias. RESULTS: The study enrolled 386 patients, 40 of whom had been receiving statin therapy before the onset of AMI. The clinical characteristics of the 2 groups were similar at baseline, with the exceptions of a significantly higher rate of hyperlipidemia in the statin group compared with the nonstatin group (P < 0.001), significantly greater chronic use of aspirin therapy (P < 0.001), and significantly greater chronic use of antihypertensive medications (beta-blockers: P = 0.004; angiotensin-converting enzyme inhibitors/angiotensin II-receptor blockers: P = 0.007; calcium channel blockers: P = 0.006). Electrocardiographic ST segment resolution after PCI was observed in 87.5% and 69.9% of the statin and nonstatin groups, respectively (hazard ratio [HR]: 3.01; 95% CI, 1.15-7.90; P = 0.025). Achievement of TIMI grade 3 flow after PCI was seen in 95.0% of the statin group and 83.5% of the nonstatin group (HR: 3.75; 95% CI, 0.88-16.0; P = NS). Patients treated with a statin had a significantly lower mean (SD) maximum CK level compared with the nonstatin group (2300 [1449] vs 3538 [3170] IU/mL, respectively; P = 0.015) and a lower cTFC after PCI (18.8 [4.0] vs 24.2 [14.2]; P = 0.017). The difference in reperfusion arrhythmias between groups was not statistically significant. After adjustment for baseline covariates, pretreatment with a statin was found to be an independent predictor of ST segment resolution after PCI (HR: 2.95; 95% CI, 1.08-8.09; P = 0.035) and prevention of impaired coronary flow (HR: 3.00; 95% CI, 1.63-5.55; P < 0.001). CONCLUSION: In this study, receipt of chronic statin therapy before the onset of AMI was associated with improvement in epicardial perfusion and a reduction in myocardial necrosis after PCI.     

急性心肌梗塞早期梗塞部位对应导联ST段压低的临床意义

探讨急性心肌梗塞部位对应导联ST段压低的意义。对245例初发急性心肌梗塞（AMI）患者发病72小时内12导联心电图ST段变化进行了分析。结果：合并梗塞部位对应导联ST段压低者占38．78％；单变量分析合并ST段压低者多见于高龄及女性，其高血压、糖尿病、广泛前壁心肌梗塞（心梗）、下壁合并后壁或右室心梗、心原性休克、心力衰竭、恶性心律失常等并发率均与无ST段压低者有显著性差异（P均＜0．001）；多变量分析示：高龄、糖尿病、广泛前壁梗塞、下壁合并后壁梗塞或右室梗塞可作为梗塞部位对应导联ST段压低的独立指征。表明AMI早期梗塞部位对应导联ST段压低是一个简单、快速、有效的初步判断梗塞范围和预后的良好指标。     

Consideration for primary angioplasty: impact on the door-to-drug time in AMI patients ultimately treated with thrombolytic agent

The objective of this study was to determine if consideration for percutaneous transluminal coronary angioplasty (PTCA) delays administration of thrombolytic therapy in acute myocardial infarction (AMI) patients. Retrospective medical record review of patients ultimately diagnosed with AMI who presented to the ED with chest pain and ST segment elevation on the electrocardiogram; these patients also received acute reperfusion therapy (PTCA or thrombolytic agent). AMI was diagnosed by abnormal elevations in the creatinine phosphokinase MB fraction. The study period covered 2 years (July 1, 1994 to June 30, 1996) in a university hospital ED with an annual volume of 60,000 patient-visits. The use of reperfusion therapies, time intervals, and times of presentation were recorded. Patients were divided into two groups based on cardiac catheterization laboratory (CATH) availability: (group I, CATH currently in operation, Monday to Friday, 7 am to 7 pm and group II, CATH currently not in-operation, all other times). Fifty-two patients with AMI met entry criteria. Patients were treated with thrombolytic therapy in 25 cases; PTCA in 27 cases. Patients received thrombolytic agents within statistically equivalent time intervals regardless of the period of presentation; time to thrombolytic therapy for group I patients was 38 +/- 16 minutes compared with 36 +/- 26 minutes for group II patients (P =. 891). A trend toward significance was noted in the use of PTCA compared with thrombolytic agent; Group I patients were more often treated with PTCA (19) compared with group II patients (11, P =.067). Patients were more rapidly treated with PTCA during CATH operation; the mean time to PTCA for group I patients was 73.5 minutes compared with PTCA for group II patients with 107.8 minutes (P =.033). The consideration for PTCA did not significantly delay the administration of thrombolytic therapy at the study site institution. PTCA was initiated more rapidly in patients presenting with AMI during hours of CATH operation.