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。     

Further elevation of the ST segment during the first hour of thrombolysis: A possible early marker of reperfusion

OBJECTIVES: To evaluate the clinical implications of early electrocardiographicchanges during thrombolysis in a randomized study in patientswith an acute myocardial infarction. BACKGROUND: Re-elevation of a rapidly resolving ST segment during thrombolysisis currently interpreted as a sign of re-occlusion, but a furtherelevation at very early stages of lytic therapy may not necessarilyhave the same implications. METHODS: In 214 patients with a first transmural acute myocardial infarctionof 4 h randomized to fibrinolytic (streptokinase group, n: 110)vs non fibrinolytic medical therapy (control group, n: 104),a standard 12 lead ECG was continuously recorded during thefirst 60 min and at 2, 4, 10, 16 and 24 h. Serial enzymes weremeasured during 72 h, and in 156 patients (73%) a coronary angiogramwas performed at 10–15 days. RESULTS: Within the first 20–40 min there was an additional STsegment elevation in 50 patients (45%) from the streptokinasegroup and in 19 from control group (18%) (P<0·0001)but the increment was greater in the streptokinase group (1·2± 1·4 vs 0·3 ± 1·4 mm, P<0·0001).In the streptokinase group, the interval from onset of painto peak creatine kinase MB was shorter in patients with additionalST segment elevation than in those without it (699 ±193 vs 856 ± 299 min, P<0·01). Moreover, in-hospitalmortality tended to be lower in patients whose ST segment waselevated than in those without such elevation (2150, 4%, vs6160, 10%). Incidence of recanalization was high but comparablein these two subsets. In recanalized patients, with or withoutadditional ST segment elevation, the ST segment declined significantlyat 1 h (– 1·0 ± 1·7, P<0·001,vs 0·1 ± 1·5 mm, ns). CONCLUSIONS: Additional ST segment elevation is frequently observed duringthe first hour of intravenous thrombolysis with streptokinase.Its association with a subsequent early decline of ST elevation,reduced mortality, a shorter time interval to peak creatinekinase, and a high rate of late recanalization, suggest thatin some patients it is one of the earliest markers of reperfusion.     

Further elevation of the ST segment during the first hour of thrombolysis: A possible early marker of reperfusion

OBJECTIVES: To evaluate the clinical implications of early electrocardiographicchanges during thrombolysis in a randomized study in patientswith an acute myocardial infarction. BACKGROUND: Re-elevation of a rapidly resolving ST segment during thrombolysisis currently interpreted as a sign of re-occlusion, but a furtherelevation at very early stages of lytic therapy may not necessarilyhave the same implications. METHODS: In 214 patients with a first transmural acute myocardial infarctionof 4 h randomized to fibrinolytic (streptokinase group, n: 110)vs non fibrinolytic medical therapy (control group, n: 104),a standard 12 lead ECG was continuously recorded during thefirst 60 min and at 2, 4, 10, 16 and 24 h. Serial enzymes weremeasured during 72 h, and in 156 patients (73%) a coronary angiogramwas performed at 10–15 days. RESULTS: Within the first 20–40 min there was an additional STsegment elevation in 50 patients (45%) from the streptokinasegroup and in 19 from control group (18%) (P<0.0001) but theincrement was greater in the streptokinase group (1.2 ±1.4 vs 0.3 ± 1.4 mm, P<0.0001). In the streptokinasegroup, the interval from onset of pain to peak creatine kinaseMB was shorter in patients with additional ST segment elevationthan in those without it (699 ± 193 vs 856 ± 299min, P<0.01). Moreover, in-hospital mortality tended to belower in patients whose ST segment was elevated than in thosewithout such elevation (2150, 4%, vs 6160, 10%). Incidence ofrecanalization was high but comparable in these two subsets.In recanalized patients, with or without additional ST segmentelevation, the ST segment declined significantly at 1 h (–1.0 ± 1.7, P<0.001, vs 0.1 ± 1.5 mm, ns). CONCLUSIONS: Additional ST segment elevation is frequently observed duringthe first hour of intravenous thrombolysis with streptokinase.Its association with a subsequent early decline of ST elevation,reduced mortality, a shorter time interval to peak creatinekinase, and a high rate of late recanalization, suggest thatin some patients it is one of the earliest markers of reperfusion.     

Interleukin 8 released after acute myocardial infarction is mainly bound to erythrocytes

Objective—To determine whether rapid clearance of interleukin 8 (IL-8) from plasma through binding to the erythrocyte chemokine receptor may be responsible for failure to detect IL-8 consistently after acute myocardial infarction.
Design—Plasma concentrations of IL-8 were measured at frequent intervals in 43 consecutive patients. In 21 of these, erythrocyte bound IL-8 concentrations were also measured. The influence of infarct size, type of treatment, and the presence of early successful reperfusion on IL-8 release was assessed.
Results—Peak IL-8 concentrations in plasma were raised in 31 of the 43 patients (68%). Median plasma IL-8 concentrations were 16.0 pg/ml (range 2.4 to 225.0 pg/ml) six hours after the onset of chest pain. Twelve hours after the onset of symptoms, plasma IL-8 concentrations had already returned to normal in 27 patients. In contrast, in 18 of 21 patients (86%), erythrocyte bound IL-8 concentrations were raised at between 6 and 30 hours, with a median peak value of 59.8 pg/ml (range 19 to 148 pg/ml). No correlation between peak creatine kinase MB and peak IL-8 (plasma or erythrocyte bound) was observed. There was a significant difference in peak plasma IL-8 concentrations between patients who underwent direct PTCA (19.4 pg/ml) and those who received conservative treatment (9.9 pg/ml; p = 0.0206), but no correlation with the presence of early successful reperfusion.
Conclusions—IL-8 is released in plasma after acute myocardial infarction and subsequently binds to red blood cells, resulting in only a transient rise of plasma IL-8 and a more prolonged increase of erythrocyte bound IL-8.

Keywords: acute myocardial infarction;  interleukin 8     

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ST段抬高型心肌梗死（STEMI）患者治疗后抬高的ST段下降的幅度，评价溶栓治疗过程中ST段改变对STEMI患者心功能的预测价值。方法105例急性STEMI患者，入院后行溶栓治疗，并计算溶栓后2h内ST段抬高总和的下降幅度。结果溶栓治疗2h后，ST段抬高振幅总和较溶栓治疗前下降大于50％时，病人自觉胸痛症状消失，心功能得到较好的保护。而ST段抬高振幅总和较治疗前小于50％时，患者心功能不同程度受损。结论急性STEMI患者经早期溶栓治疗后，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。     

急性ST段抬高性心肌梗死直接经皮穿刺冠状动脉成形术后早期ST段变化的意义

目的探讨急性ST段抬高性心肌梗死(STEMI)直接经皮穿刺冠状动脉成形术(PCI)术后梗死相关动脉(IRA)完全开通、前向血流恢复后,早期ST段变化的临床意义。方法回顾性分析2001-01~12北京朝阳医院心脏中心收治的216例直接PCI后、IRA完全开通、前向血流恢复正常病人的临床、冠脉造影和心电图资料。直接PCI术后,ST段抬高指数≥50%的病人41例,为病例组。从其余175例ST段抬高指数<50%的病人中随机抽取50例,为对照组。结果两组病人的ST段抬高指数、Q波计数、室壁运动积分和平均肌酸激酶值差异有显著性意义(P<0·05);术后2周,ST段早期恢复较ST段持续抬高病人的室壁运动改善,左室射血分数(LVEF)、心排指数(CI)、每搏指数(SVI)增加(P<0·05)。ST段早期恢复合并心功能不全的病人,术后2周室壁运动增强,LVEF、CI、SVI增加(P<0·05),左室舒张末容积、左室收缩末容积减少(P<0·01)。结论STEMI直接PCI后IRA完全开通、前向血流恢复正常而ST段持续抬高病人的梗死范围扩大,左室舒缩功能不全严重,可能与心肌组织没有有效地恢复血流灌注或无复流有关。     

Transferring patients for primary angioplasty: a retrospective analysis of 104 selected high risk patients with acute myocardial infarction

Objective—To investigate the feasibility of primary coronary angioplasty as a treatment option in patients with acute myocardial infarction after initial diagnosis in a local community hospital.
Setting—Referral centre for interventional treatment of coronary artery disease.
Methods—During a five year period, 520 candidates for primary coronary angioplasty were treated in our institution, 104 after transfer from a community hospital. The transferred patients and the non-transferred patients (n = 416) were compared with regard to baseline clinical characteristics, time interval from symptom onset to treatment, and clinical outcome at six months.
Results—In this setting, the influence of transportation on total ischaemic time was limited, and there was no difference in clinical outcome between the transferred and the non-transferred patients. Clinical outcome was mainly dependent on the indication for transfer.
Conclusions—Safe and expedient transportation may facilitate the more widespread use of primary angioplasty in patients with acute myocardial infarction. A large randomised multicentre trial is needed to compare the relative merits of intravenous thrombolytic treatment in a local hospital with primary angioplasty after transfer in selected high risk patients with acute myocardial infarction.

Keywords: myocardial infarction;  coronary angioplasty;  reperfusion     

急性ST段抬高心肌梗死的最佳支架植入时机:即刻与延迟植入比较的Meta分析

目的:收集比较有关发生急性ST段抬高心肌梗死(STEMI)时即刻植入支架(IS)和延迟植入支架(DS)的随机对照和队列研究,对其结果进行系统评价和Meta分析,比较IS和DS的安全性和有效性。方法:在PubMed、Cochrane Library、中国知网3大数据库检索2017年5月前关于比较IS和DS安全性和有效性的文章,将IS患者作为实验组(IS组),DS患者组作为对照组(DS组),以主要心脏不良事件(MACE)发生率、慢血流/无复流发生率、远端栓塞发生率、靶病变血管开通率(TIMI 3级)、靶血管再次血运重建(TVR)率、主要出血发生率、再次心肌梗死发生率作为观察指标,使用Review Manager 5.3软件进行Meta分析,计算对应的OR值和95%CI,并分析异质性及其来源。结果:最终有8篇文献纳入Meta分析,包括2 181例患者,其中IS组1 262例,DS组919例。与IS相比,DS能够显著降低慢血流/无复流发生率(OR=4.55,95%CI:2.14~9.68)、远端栓塞发生率(OR=9.14,95%CI:3.47~24.10),提高靶病变血管开通率(TIMI 3级)(OR=0.22,95%CI:0.12~0.43);然而两组在MACE发生率、TVR率、再次心肌梗死发生率、主要出血发生率方面相比无明显差异。结论:在STEMI患者中,DS与IS在MACE发生率、TVR、再次心肌梗死发生率与主要出血发生率方面无明显差异;DS慢血流/无复流发生率与远端栓塞发生率均较IS低,靶病变血管开通率(TIMI 3级)较IS高。     

Age dependent efficacy of implantable cardioverter-defibrillator treatment: observations in 450 patients over an 11 year period

Objective—To determine whether implantable cardioverter-defibrillator (ICD) treatment is beneficial in elderly patients with life threatening ventricular tachyarrhythmias.
Design—Since January 1984, ICDs were implanted in 450 patients to evaluate surgical risk, complications and mean survival in relation to patient age; 81 patients (18%) were  50 years at the time of ICD implant, 254 patients (56%) were between 51 and 64 years, and the remaining 115 (26%) were  65 years. Epicardial lead systems were implanted in 209 patients (46%), while transvenous lead systems were implanted in 241 (54%).
Results—13 patients (3%) died perioperatively, more often after epicardial (11 of 209 patients, 5%) than after transvenous ICD implantation (one of 241 patients, < 1%) (p < 0.05). During a mean (SD) follow up of 28 (24) months (range < 1 to 114 months), 90 patients (20%) died. Of these, nine (2%) died from sudden arrhythmic death; five (1%) died suddenly, probably as a result of non-arrhythmic causes; 55 (12%) died from other cardiac causes (congestive heart failure, myocardial infarction); and 21 (5%) died from non-cardiac causes. The three, five, and seven year survival for arrhythmic mortality was 95% in patients  50 years compared with a three year survival of 93% and a five and seven year survival of 91% in patients of 51 to 64 years, and a three, five, and seven year survival of 99% in patients  65 years. 362 patients (80%) received ICD discharges (21 (43) shocks per patient), with a similar incidence among all three patient groups ( 50 years, 80%; 51 to 64 years, 81%; 65 years, 79%). The time interval between ICD implant and the first ICD treatment was shorter in patients  65 years (8 (8) months) than in patients between 51 and 64 years (11 (14) months) or  50 years (11 (11) months) (p < 0.05). Survival time following first appropriate shock was 30 (24) months in patients  50 years, 30 (26) months in patients of 51 to 64 years, and 19 (20) months in patients  65 years.
Conclusions—Elderly patients benefit from ICD treatment, and survive for a considerable time after the first treatment. Therefore, elderly patients should be considered candidates for ICD implantation if life threatening ventricular tachyarrhythmias are present.

Keywords: cardioverter-defibrillator;  heart failure;  sudden death;  ICD discharges;  elderly patients     

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。     

aVR导联ST段抬高对急性心肌梗死预后的价值

目的探讨心电图aVR导联ST段抬高对急性前壁心肌梗死患者预后的价值。方法首次入院急性前壁心肌梗死患者57例，对其心电图和冠状动脉造影及临床资料进行对比分析。根据心电图aVR导联ST段变化分为抬高组、无偏移组。结果梗死相关血管为左主干病变的ST段抬高组、ST段无偏移组分别为5例（21．7％）、1例（2．9％），两组统计有显著性差异（p〈0．01）；病变范围为多支病变ST段抬高组、ST段无偏移组分别为10例（43．4％）、8例（23．5％），两组统计有显著性差异（p〈0．05）；发生心脏事件ST段抬高组、ST段无偏移组分别为8例（34.8％）、3例（8．8％），两组有显著性差异（p〈0．01）。结论aVR导联ST段抬高对预测急性前壁心肌梗死患者的预后有重要的价值，应高度重视。     

高龄急性ST段抬高型心肌梗死患者临床特征及冠脉造影分析

【摘要】 目的 探讨高龄急性ST段抬高型心肌梗死( STEMI) 患者的临床特征及冠状动脉造影特点。方法 将临床确诊为STEMI年龄≥75 岁的97例患者( 高龄组) 与＜75岁的92例患者( 非高龄组) 进行对照研究,分析其临床特征和冠状动脉造影特点。结果 高龄组的STEMI 危险因素中合并高血压、糖尿病、高血脂、陈旧性心肌梗死、脑卒中史及肺功能减退的比例高于非高龄组,而吸烟史和AMI 阳性家族史低,但差异无统计学意义。高龄患者既往经皮冠状动脉介入治疗（PCI）、肾功能减退（肾小球滤过率降低）较对照组多, 分别是(24.7% VS 10.9%;52.1 4.2 VS 63.7 2.3ml/min.1.73 m2,P<0.05 )。高龄组不典型胸痛更多见,约占34.1%,主要表现为呼吸困难（16.5% VS 6.5%,P<0.05）。其他症状,如消化道症状及晕厥,未达到统计学差异 （13.4% VS 5.4%, P>0.05;5.2% VS 5.4%, P>0.05）。心功能KillipⅠ级在高龄组低于对照组(51.5% VS 71.7%,P<0.01),而KillipⅡ-Ⅲ级则高于对照组(38.2% VS 22.9%,P<0.05),均具有统计学意义。高龄组冠脉多支病变、侧支建立、复杂病变明显高于对照组,分别是（81.4% VS 65.2%,P<0.05;82.5% VS 68.5%,P<0.01;61.1% VS 47.8%,P<0.05）,差别具有统计学意义。结论 高龄STEMI患者既往PCI、肾功能减退、不典型胸痛更多见,冠状动脉多支病变、侧支建立、复杂病变的发生率显著增高。     

血栓弹力图评价替格瑞洛和氯吡格雷在急性ST段抬高型心肌梗死中抗血小板的疗效

目的:通过血栓弹力图评价替格瑞洛和氯吡格雷在急性ST段抬高型心肌梗死(STEMI)中抗血小板的疗效。方法:60例STEMI患者分为两组,阿司匹林+氯吡格雷组(Ⅰ组,n=30)和阿司匹林+替格瑞洛组(Ⅱ组,n=30),于抗血小板药物负荷剂量给药2 h后和维持治疗3个月后,使用血栓弹力图检测花生四烯酸(AA)途径和二磷酸腺苷(ADP)受体途径诱导的血小板抑制率。结果:抗血小板药物负荷剂量给药2 h后和维持治疗3个月后,Ⅱ组ADP受体途径诱导的血小板抑制率均明显高于Ⅰ组[(54.67±5.83)%对(45.75±16.72)%,P0.05;(59.53±12.18)%对(45.10±16.26)%,P0.05],AA途径诱导的血小板抑制率两组间无明显差异,患者的出血和缺血事件发生率两组间无明显差异。结论:替格瑞洛较氯吡格雷在STEMI治疗中能更快速充分地抑制血小板,血栓弹力图可用于指导STEMI患者抗血小板治疗。     

Dobutamine- vs exercise-induced ST segment elevation early after Q wave myocardial infarction. Prediction of functional recovery after revascularization.

AIMS: The association between stress-induced ST elevation and functional recovery following revascularization after myocardial infarction remains unclear. We assessed the relative accuracy of dobutamine- and exercise-induced ST elevation in Q wave leads in predicting functional recovery following revascularization, and we investigated the relationship of ST elevation to different wall motion responses to dobutamine. METHODS AND RESULTS: Thirty-nine patients underwent dobutamine stress echo and exercise test 8+/-2 days after Q wave myocardial infarction. All patients underwent angiography and subsequent revascularization. Follow-up echocardiograms were obtained 7+/-4 weeks after revascularization. Functional recovery was assessed by the difference between the baseline and the follow-up asynergy index. Nineteen patients (48%) developed dobutamine- and exercise-induced ST elevation. There was significant agreement between the tests (k=0.58, P<0.001). We found a significant correlation between dobutamine and exercise-induced ST elevation with functional recovery following revascularization (r=0. 45, P<0.005 and r=0.7, P<0.001, respectively). The parameters with the highest predictive value for functional recovery were: (a) the biphasic response during dobutamine infusion, (b) the development of ST elevation in both tests, and (c) the development of exercise-induced ST elevation in more than three leads. CONCLUSION: There is a strong association between dobutamine- and exercise-induced ST elevation with functional recovery following revascularization. Exercise-induced ST elevation in more than three leads and a biphasic response during dobutamine infusion accurately predict functional recovery.     

von Willebrand factor, tissue plasminogen activator, and dehydroepiandrosterone sulphate predict cardiovascular death in a 10 year follow up of survivors of acute myocardial infarction

Background—Haemostasis plays a major part in the process initiating a myocardial infarction. The impact of haemostatic variables on long term prognosis is unknown.
Objective—To evaluate von Willebrand factor (vWF), tissue plasminogen activator antigen (t-PA) and its activity before and after venous occlusion, plasminogen activator inhibitor (PAI-1), dehydroepiandrosterone sulphate (DHEAS), and established clinical risk factors as long term predictors for reinfarction and mortality.
Patients—123 consecutive survivors of myocardial infarction followed up for 10 years.
Design—Study entry took place between 1982 and 1983. Fifty seven patients died (54 of cardiovascular disease) during the mean observation time of 10 years.
Results—Cox's univariate regression analysis showed that cardiovascular mortality was significantly associated with age, hypertension, previous history of angina pectoris, DHEAS, mass concentration of t-PA, and vWF. These associations were significant for vWF and mass concentration of t-PA after adjusting for age and hypertension.
Conclusions—A low concentration of DHEAS and high levels of the endothelially derived haemostatic variables vWF and mass concentration of t-PA are predictors of cardiovascular mortality in survivors of myocardial infarction. This association is independent of established clinical risk factors for mass concentration of t-PA and vWF.

Keywords: myocardial infarction;  risk factors;  fibrinolysis;  tissue plasminogen activator;  plasminogen activator inhibitor;  von Willebrand factor;  dehydroepiandrosterone sulphate     

ST段抬高型心肌梗死患者血小板计数/淋巴细胞与冠状动脉病变程度及短期预后的相关性

【摘要】目的 探讨ST段抬高型心肌梗死患者血小板计数/淋巴细胞比值（PLR）水平的变化与冠状动脉病变程度的相关性及PLR对两个月全因死亡率的预测价值。 方法 我院选取2013年4月到2015年4月期间行急诊经皮冠状动脉介入治疗的120例ST段抬高型心肌梗死患者,根据冠状动脉病变的SYNTASX积分评价,将120例患者分为严重冠状动脉病变组和非严重冠状动脉病变组,严重冠状动脉病变组（SYNTASX积分>25）72例,非严重冠状动脉病变组（SYNTASX积分≤25）48例。根据PLR三分位将120例患者分为高PLR组（PLR≥210）42例,中PLR组（210>PLR>90）21例,低PLR组（PLR≤90）57例。分析PLR水平的变化与冠状动脉病变程度的相关性及PLR对两个月全因死亡率的预测价值。结果 在72例患者的严重冠状动脉病变组和有48例患者的非严重冠状动脉病变组中,非严重冠状动脉病变组的血小板计数和PLR明显低于严重冠状动脉病变组的血小板计数,数据有统计学意（P<0.05)。非严重冠状动脉病变组的淋巴细胞计数和高密度脂蛋白胆固醇明显高于严重冠状动脉病变组的淋巴细胞计数和高密度脂蛋白胆固醇,数据有统计学（P<0.05)。非严重冠状动脉病变组中多支血管病变比例,替罗非班使用率,血栓抽吸使用率,两个月全因累积死亡率,明显低于严重冠状动脉病变组,差异具有统计学意义（P<0.05)。SYNTAX的风险比为1.4,95%可信区间为（1.2,1.9）,其与患者两个月全因死亡有关联性（P<0.05）。PLR的风险比为1.2,95%可信区间为（1.3,2.0）,其与患者两个月全因死亡有关联性（P<0.05）。结论 PLR与ST段抬高型心肌梗死患者的冠状动脉病变程度密切相关,对于患者预后具有一定的预测价值,患者可以通过PLR值了解自己的病情并及时治疗。     

A survey of primary percutaneous coronary intervention for patients with ST segment elevation myocardial infarction in Canadian hospitals

BACKGROUND:

Historically, access to primary percutaneous coronary intervention (PCI) for the treatment of patients with ST segment elevation myocardial infarction (STEMI) has been limited in Canada. Recent studies have identified innovative strategies to improve timely access and reduce reperfusion time. Accordingly, the contemporary use of primary PCI treatment in Canada was ascertained.

METHODS:

A cross-sectional survey of all 38 Canadian hospitals that were capable of performing PCI procedures was conducted from June 2007 to November 2007. The survey focused on the practice of primary PCI for patients with STEMI and whether the hospitals had implemented internal strategies to reduce ‘door-to-balloon’ times. Analyses were performed at the level of geographical regions.

RESULTS:

Overall, 71% of PCI hospitals (27 of 38) provided around-the-clock primary PCI for patients with STEMI, but the proportion of PCI hospitals offering this service varied widely, from 33% to 100% across regions. All Canadian PCI hospitals provided around-the-clock rescue PCI treatment to STEMI patients who had failed fibrinolytic therapy. In terms of strategies that are associated with reduced reperfusion time, it was observed that only 42% of PCI hospitals (16 of 38) provided feedback on door-to-balloon time to the emergency department and to the cardiac catheterization laboratories within one week of the primary PCI procedure. Overall, 24% of the hospitals had not adopted any of the four identified strategies to improve door-to-balloon time.

CONCLUSION:

Although the majority of Canadian hospitals with PCI capability provide around-the-clock primary PCI for patients with STEMI, significant variations in this practice exist across the country. Canadian PCI hospitals have not consistently adopted strategies that are associated with improved door-to-balloon time.     

急性心肌梗死aVR导联ST段抬高的临床意义

目的 探讨体表心电图aVR导联ST段抬高对急性心肌梗死患者梗死相关血管(IRA)诊断及临床预后的意义.方法 收集2010年10月至2012年12月因急性心肌梗死入住我院的患者共240例,根据患者入院时心电图aVR导联ST段有无抬高,分为A组(AVR导联ST段抬高)80例和B组(aVR导联ST段无抬高)160例,对两组患者临床资料、冠状动脉造影结果及主要不良心血管事件进行对比.结果 ①两组患者性别、糖尿病病史、PCI病史等一般临床资料对比差异无统计学意义(P＞0.05).②两组冠状动脉造影结果比较:IRA为左主干(LM),A组9例,B组3例,两组比较差异有统计学意义(P＜0.01);IRA左主干和(或)三支血管(LM/3VD),A组46例,B组15例,两组比较差异有统计学意义(P＜0.01).③aVR导联ST抬高对IRA为左主干的敏感性及特异性分别为75％和69％,对IRA为左主干和(或)三支病变的敏感度及特异度分别为73％和81％.④住院期间主要不良心血管事件(MACE),A组36例,B组25例,两组比较差异有统计学意义(P＜0.01).⑤在住院期间,aVR导联ST段抬高(OR=10.03,95％CI=5.36～18.77,P＜0.01)是急性心肌梗死患者发生不良心血管事件的独立危险因素.结论 aVR导联ST段抬高提示急性心肌梗死患者梗死相关血管为左主干和(或)三支血管病变及住院期间不良心血管事件发生率增高.aVR导联ST段抬高对急性心肌梗死患者梗死相关血管判断及临床预后具有一定的临床指导意义.