急性心肌梗死后左心功能及室壁运动恢复与ST段的变化关系

目的探讨急性心肌梗死(AMI)患者接受直接经皮冠状动脉腔内成形术(PTCA)治疗后左室收缩功能及梗死区室壁运动恢复与心电图抬高ST下降幅度的关系。方法接受直接PTCA的AMI患者共34例,比较PTCA前及术后1h12导联心电图抬高ST段的总和,按ST段下降幅度分为两组A组ST段下降≥50％;B组ST段下降＜50％。所有患者于发病第(7±2)d行小剂量多巴酚丁胺超声心动图负荷试验并于发病第1、2、3个月行超声心动图检查。结果AMI发病急性期基础状态和负荷状态及发病后第1、2、3个月左室射血分数(LVEF)A组均明显大于B组(63.4vs56.7;68.9vs60.5;60.1vs53.1;61.4vs53.1;60.9vs52.3;P均<0.05)。基础状态和多巴酚丁胺负荷状态下总室壁运动积分指数(GWMSI)和梗死区室壁运动积分指数(IWMSI)A组均明显小于B组。AMI发病第1、2、3个月GWMSIA组均明显小于B组(1.21vs1.38,P=0.042;1.17vs1.38,P=0.015;1.18vs1.30,P=0.035)。发病第1、2个月IWMST两组间无统计学差异。发病第3个月IWMSTA组明显小于B组(2.16vs2.47,P=0.048)。结论急性心肌梗死直接PTCA后心电图ST段下降幅度≥50％组在AMI急性期和恢复期左室收缩功能及梗死区室壁运动的恢复均明显优于ST段下降幅度<50％组。     

急性前壁心肌梗死时下壁导联ST段压低的意义

目的：探讨前壁急性心肌梗死（AMI）时心电图（ECG）下壁导联ST段压低的意义。方法：对59例前壁AMI病人（甲组29例伴下壁导联ST段压低、乙组30例不伴下壁导联ST段压低）的ECG及发病2个月内选择性冠状动脉造影和同位素心肌灌注显像检查结果对照分析。结果：①选择性冠状动脉造影显示冠状动脉病变（狭窄＞50．00％）支数在两组间的分布无显著差异（P＞0．05）;左心室造影两组均未见下壁运动明显减弱。②同位素心肌灌注显示甲组病人86．21％无下壁心肌缺血表现。③甲组ECGV1-3导联ST段抬高和的平均值明显高于乙组（P＜0．05）,ECG下壁导联ST段压低主要受V1-3导联ST段抬高程度的影响（r＝-0．528,P＜0．05）。结论：前壁AMI时ECG下壁导联ST段的压低可能是对前壁V1-3导联ST段抬高的镜影反映,而不提示伴有下壁心肌缺血。     

急性心肌梗死患者直接PCI治疗后心电图ST段抬高、BNP变化对左室重构的意义

目的观察急性心肌梗死（AMI）患者接受经皮冠状动脉介入治疗术（PCI）治疗后心电图ST段、血浆中BNP的水平变化与左室重构（LVRM）之间的关系，探讨心电图ST段、BNP对LVRM的预测价值。方法首次AMI患者共48例，比较PCI前及术后1h 12导联心电图抬高ST段的总和，按ST段下降幅度分为两组，A组：37例，ST段下降≥50％；B组：11例，ST段下降〈50％；治疗前及治疗后第7d，采用电化学发光法对血浆BNP水平进行检测；并随访复查AMI后2～3d及第3个月超声心动图。结果PCI治疗后BNP水平，A组明显小于B组；A、B组治疗前、后BNP间差异均有显著性意义（P〈0．05）。B组患者PCI治疗后2～3d及3个月时LVEDD比较，B组LVRM发生率与A组间差异均有显著性意义（P〈0．05）。结论急性心肌梗死患者直接PCI治疗后心电图ST段和BNP持续抬高对于预测左室重构有重要意义。     

非ST段抬高型与ST段抬高型急性心肌梗塞冠脉造影病变的对比

目的：比较非ST段抬高型与ST段抬高型急性心肌梗塞（AMI）病人冠状动脉血管造影结果。方法：回顾分析我院接受冠脉造影的268例AMI患者的资料,患者被分为A、B两组：A组为非ST段抬高型AMI（NSTEMI）。共148例,B组为ST段抬高型AMI（STEMI）,共120例。结果：非ST段抬高型AMI组冠脉造影病变的血管数及血管狭窄程度明显高于ST段抬高型AMI组的（P〈0．01）。4年随访中NSTEMI组死亡19例（12．8％）。STEMI组死亡9例（7．5％）,NSTEMI组死亡率显著高于STEMI组（P〈0．01）。结论：非ST段抬高型AMI的病情较ST段抬高型AMI更重。     

急性心肌梗死时心电图ST段抬高恢复时间对预测溶栓治疗后心室壁运动的临床意义

目的　探讨急性心肌梗死时 (AMI)心电图ST段抬高恢复时间对预测溶栓治疗后心室壁运动的临床意义。方法　将监护病房 (CCU)收治并接受静脉尿激酶溶栓治疗且符合梗死相关血管再通标准的 36 0例AMI患者 ,根据溶栓后心电图ST段抬高达到稳定性下移 5 0 %的时间 ,分成A组 (时间在 30min内 ,n =92 )、B组(6 0min内 ,n =12 6 )及C组 (90min ,n =14 2 ) ,分别测定 3组的梗死血管室壁运动的幅度。结果　ST段抬高达到稳定性下移 5 0 %所需要的时间不同 ,梗死相关心室壁运动幅度存在差异 [急性前壁心肌梗死 (AAMI)相关室间隔运动幅度A、B、C 3组分别为 (8 15± 1 6 2 )、(7 84± 1 4 3)及 (6 5 6± 2 15 )mm ,P <0 0 5 ;急性下壁心肌梗死 (AI MI)相关左室后壁运动幅度 3组分别为 (8 78± 1 92 )、(7 32± 1 5 4 )及 (6 15± 2 0 5 )mm ,P <0 0 5 ,且随需要的时间延长 ,梗死相关的心室壁运动幅度有下降的趋势。结论　抬高的ST段恢复时间越短 ,梗死相关的心室壁运动改善越明显     

抬高的ST段恢复时间对预测溶栓治疗后室壁运动的临床意义

目的 :探讨抬高的ST段恢复时间对预测溶栓治疗后室壁运动的临床意义。方法 :将冠心病监护病房收治并接受静脉尿激酶溶栓治疗且符合梗死相关血管再通标准的 180例AMI患者 ,根据溶栓后心电图抬高的ST段达到稳定下移 5 0 %的时间 ,分成A组 (时间在 30min内 ,n =4 6 )、B组 (6 0min内 ,n =6 3)及C组 (90min内 ,n =71) ,分别测定 3组的梗死血管室壁运动幅度。结果 :抬高的ST段达到稳定下移 5 0 %所需的时间不同 ,梗死相关室壁运动幅度存在差异〔急性前壁心肌梗死相关室间隔运动幅度A、B、C 3组分别为 (8.15± 1.6 2 )、(7.84± 1.4 3)及 (6 .5 6± 2 .15 )mm ,P <0 .0 5 ;急性下壁心肌梗死相关左室后壁运动幅度 3组分别为 (8.78±1.92 )、(7.32± 1.5 4 )及 (6 .15± 2 .0 5 )mm ,P <0 .0 5〕 ,且随需要的时间延长 ,梗死相关的室壁运动幅度有下降的趋势。结论 :抬高的ST段恢复时间越短 ,梗死相关的室壁运动改善越明显     

持续监测ST段对评估急性心肌梗死早期梗死相关动脉动态变化的意义

目的 持续监测ST段变化评估急性心肌梗死（AMI）早期梗死相关动脉（IRA）动态变化的意义。方法 对发病≤6h的55例（男40例,女15例,年龄39－80岁）AMI患进行动态心电图监测,持续观察24hST段变化并与冠状动脉造影结果作对照。结果 （1）IRA未开通ST段持续抬高并伴有逐渐下降趋势.(2)溶栓疗法和直接经皮冠状动脉腔内形成术成功后ST段迅速下降并保持相对稳定。（3）所有患24h内均见有间断的ST段抬高和下降的波动性变化,尤其多见于溶栓成功早期。结论 AMI发病早期IBA处于动态的开放－关闭状态,持续监测ST段可较全面反应IRA变化。     

急性心肌梗死直接PTCA后早期ST段改变及其临床意义

目的探讨急性心肌梗死（AM I）行直接经皮冠状动脉腔内成形术（PTCA）+支架术后心电图早期ST段回落幅度与左心室结构、功能的关系。方法首次患AM I并接受直接PTCA的患者32例。比较PTCA术前和术后1 hST段抬高的高度,按ST段下移>50%及ST段下移<50%,分别分为A组（21例）和B组（11例）。所有患者于术后4周进行临床评估和二维彩色多普勒超声心动图检查。结果随访期间两组患者均未发生死亡,A组心功能ⅢⅣ级2例,B组心功能ⅢⅣ级5例（P<0.05）。4周后A组左心室射血分数（LVEF）、收缩末容积指数（LVESVI）、舒张末容积指数（LVEDVI）和全心室壁运动指数（GWMSI）均显著优于B组（P<0.05）;梗死区室壁运动指数（RWMSI）在两组间无显著性差异。结论成功的直接PTCA后ST段的早期回落是反映心肌组织再灌注的简便可靠的指标,ST段回落>50%者的心脏功能、室壁运动及左心室重构情况明显优于ST段回落<50%者。     

急性前壁心肌梗死经皮冠状动脉血运重建术后ST段持续抬高对其晚期左室功能的影响

目的:探讨急性前壁心肌梗死(MI)患者行直接经皮冠状动脉血运重建术(PCI)后心电图ST段持续 性抬高对MI后晚期左室功能和临床预后的影响。方法:选择因急性前壁MI入院成功接受直接PCI的患者72 例,动态观察PCI前后心电图ST段的变化,以PCI后1hST段下降>50%为ST段下降组,相反为ST段抬高 组。应用超声心动图测定MI后早期(2～3周)和晚期(5～6个月)左室功能和室壁活动异常的变化,并随访其间 心血管事件的发生率。结果:ST段下降组53例(73.6%),ST段抬高组19例(26.4%)。MI后早期两组间左室 功能和室壁活动异常(VWMA)无明显差异;晚期ST段抬高组左室射血分数(LVEF)明显低于ST段下降组(P <0.05),而左心室舒张末期容积指数(LVEDVI)、左心室收缩末期容积指数(LVESVI)和VWMA积分均明显高 于ST段下降组(P<0.05,P<0.01)。随访期间ST段抬高组主要心血管事件的发生率略高于ST段下降组, 但差异无统计学意义。ST段下降组MI前心绞痛和直接支架术的比例明显高于ST段抬高组(P<0.05)。结 论:ST段持续性抬高者MI晚期左室功能较差,有MI前心绞痛和直接支架术者PCI后ST段持续性抬高的发生 率可能较低。     

急性下壁心肌梗死累及侧后壁或右心室对下壁及胸前导联ST段的影响

下壁和胸前导联 ST段改变是急性下壁心肌梗死 ( AIMI)时常见的心电图 ( ECG)表现。本文分析63例 AIMI伴 (或不伴 )侧后壁 ( LPMI)或右心室梗死 ( RMI)患者的 ECG,旨在探讨其对下壁及前壁导联 ST段的影响及其临床意义。1　对象与方法1 996年 1月～ 2 0 0 0年 1 0月 ,我院收治首次AIMI患者 63例 ,所有患者均符合 WHO的 AMI诊断标准 ,且在发病后 1 2 h内入院 ,所有患者有明确的胸痛史 ,典型的 、 、a VF导联 ST段抬高及心肌酶学动态演变。 RMI者有 2次以上 ECG示V3 R～ 5R连续≥ 2个导联 ST段抬高 >1 mm,其中V4 R导联 S…     

直接经皮冠状动脉腔内成形术中冠状动脉内心电图判定存活心肌的价值

目的 应用99mTc-MIBI心肌断层显像(SPECT)评价冠状动脉内心电图(IC-ECG)判定急性心肌梗死(AMI)存活心肌的价值。方法 56例急性前壁心肌梗死患者，接受了直接经皮冠状动脉腔内成形术(PTCA)，梗死相关动脉前降支(LAD)达到TIMI3级血流后IC-ECG自PTCA导引导丝尾端引出作为参照基线，在进一步球囊扩张时IC-ECG ST段再次抬高大于0．2mV时认为具有判定梗死相关部位有存活心肌的意义。测定并比较急性期及恢复期左心室梗死相关区域节段性缩短率(LVSS)与射血分数(LVEF)，梗死区域存活心肌通过恢复早期静息与硝酸甘油介入两次99mTc-MIBI SPECT量化判定。结果 4l例病人(A组)行直接PTCA时IC-ECG ST段明显抬高，15例(B组)未出现相应变化，A组INSS、INEF。在恢复期均显著大于B组，两次99mTc-MIBISPECT显示，硝酸甘油介入后显像A组梗死缺损区面积明显减少，核素放射性计数百分比亦明显增加，B组则无明显改变，说明A组梗死区域有较多存活心肌，与IC-ECT ST段抬高意义一致。结论 直接PTCA过程中可通过球囊扩张时IC-ECG ST段抬高变化初步判定梗死相关区域的心肌活性。     

The significance of persistent ST elevation versus early resolution of ST segment elevation after primary PTCA

OBJECTIVES

To determine the prevalence and clinical significance of early ST segment elevation resolution after primary percutaneous transluminal coronary angioplasty (PTCA) for acute myocardial infarction (AMI).

BACKGROUND

Despite angiographically successful restoration of coronary flow early during AMI, adequate myocardial reperfusion might not occur in a substantial portion of the jeopardized myocardium due to microvascular damage. This phenomenon comprises the potentially beneficial effect of early recanalization of the infarct related artery (IRA).

METHODS

Included in the study were 117 consecutive patients who underwent angiographically successful [Thrombolysis in Myocardial Infarction (TIMI III)] primary PTCA. The patients were classified based on the presence or absence of reduction ≥50% in ST segment elevation in an ECG performed immediately upon return to the intensive cardiac care unit after the PTCA in comparison with ECG before the intervention.

RESULTS

Eighty-nine patients (76%) had early ST segment elevation resolution (Group A) and 28 patients (24%) did not (Group B). Group A and B had similar clinical and hemodynamic features before referring to primary PTCA, as well as similar angiographic results. Despite this, ST segment elevation resolution was associated with better predischarge left ventricular ejection fraction (LVEF) (44.7 ± 8.0 vs. 38.2 ± 8.5, p < 0.01). Group B patients, as compared with those of Group A, had a higher incidence of in-hospital mortality (11% vs. 2%, p = 0.088), congestive heart failure (CHF) [28% vs. 19%, odds ratio (OR) = 4, 95% confidence interval (CI) 1 to 15, p = 0.04], higher long-term mortality (OR = 7.3, 95% CI 1.9 to 28, p = 0.004 with Cox proportional hazard regression analysis) and long-term CHF rate (OR = 6.5, 95% CI 1.3 to 33, p = 0.016 with logistic regression).

CONCLUSIONS

Absence of early ST segment elevation resolution after angiographically successful primary PTCA identifies patients who are less likely to benefit from the early restoration of flow in the IRA, probably because of microvascular damage and subsequently less myocardial salvage.     

急性心肌梗死直接PCI后心电图ST段回落幅度与血管内皮功能的关系

目的:探讨急性心肌梗死(AMI)直接经皮冠状动脉介入术(PCI)后心电图ST段回落幅度与血管内皮功能的关系。方法:AMI直接PCI后梗死相关血管(IRA)血流达TIMI3级患者51例,按ST段回落幅度分为A组32例(ST段迅速回落组)和B组19例(ST段持续抬高组)。所有患者于发病(7±2)d和3个月测量肱动脉流量介导舒张(FMD)和硝酸甘油介导舒张(NMD)。正常对照组25例。结果:AMI发病1周时A组和B组FMD(5·42%±2·27%与1·99%±1·63%,P<0·05)和NMD(15·08%±8·79%与6·84%±3·92%,P<0·05)均明显低于正常对照组(FMD9·60%±3·41%,NMD22·17%±8·49%);AMI发病后3个月A、B2组的FMD(9·06%±1·98%与5·44%±1·91%,P<0·01)和NMD(20·90%±5·78%与12·93%±4·71%,P<0·01)均较基础状态增加,A组内皮功能基本恢复正常,B组虽然有恢复但未达到正常状况。结论:AMI血管内皮功能明显受损,成功再灌注后ST段持续抬高的患者受损更明显。随着时间的延长内皮功能有所恢复,ST段持续抬高的患者恢复差于ST段迅速回落者。     

Early identification of impaired myocardial reperfusion with serial assessment of ST segments after percutaneous transluminal coronary angioplasty during acute myocardial infarction.

To evaluate the relation between ST-segment analysis and microvascular reperfusion in patients with acute myocardial infarction (AMI), we studied 51 patients with first AMI who were successfully treated by percutaneous transluminal coronary angioplasty (PTCA). The lead showing the greatest ST-segment elevation on the 12-lead electrocardiogram (ECG) was serially investigated until 24 hours after PTCA. Successful reperfusion was determined by technetium-99m tetrofosmin single-photon emission computed tomography. Impaired reperfusion (group 1: < 4 change in the sum of the defect score from before to immediately after PTCA) was observed in 24 patients, and successful reperfusion (group 2) was observed in 27 patients. Although ST-segment elevation was reduced significantly at 30 minutes after PTCA in group 2 (2.2 +/- 1.4 to 1.7 +/- 1.3 mm, p = 0.01), there was no significant change in group 1 (1.9 +/- 1.9 to 2.4 +/- 1.7 mm). Ten of 14 patients (71%) with persistent ST-segment elevation (DeltaST > 0 mm change in ST segment from before to 30 minutes after PTCA > 0) were in group 1, whereas 23 of 37 patients (62%) with ST-segment resolution (DeltaST < or = 0) were in group 2. The sensitivity and specificity of persistent ST-segment elevation for predicting impaired microvascular reperfusion were 42% and 85%, respectively. Thus, persistent ST-segment elevation 30 minutes after primary PTCA was a highly specific electrocardiographic marker of impaired reperfusion in patients with AMI.     

ST segment resolution predicts clinical outcome and response to dobutamine testing after primary percutaneous transluminal coronary angioplasty

AIM: To assess clinical outcome and improvement in left ventricular (LV) contractility during a six-month follow-up after successful primary percutaneous transluminal coronary angioplasty (PTCA), according to rapid ST segment resolution. The usefulness of early dobutamine echocardiography (DE) in the prediction of LV functional recovery in patients treated with primary PTCA was tested. PATIENTS AND METHODS: One hundred ten consecutive patients with first acute myocardial infarction after successful primary PTCA (Thrombolysis in Myocardial Infarction (TIMI) 3 flow and stenosis of less than 30%) were divided into two groups according to whether ST segment resolution occurred 1 h after the procedure. The patients underwent clinical assessment and echocardiography (ejection fraction [EF] and wall motion index [WMI]) after primary PTCA, during DE on the fourth day of hospitalization, and again after three and six months. RESULTS: In patients with ST segment resolution (n=76 [69.1%]), LVEF increased significantly during the six-month follow-up (P=0.0001). Changes found in the group without ST segment resolution were insignificant (P=0.4). Early DE in patients with rapid ST segment resolution revealed significant improvements in LV contractility measured by EF and WMI. Patients without ST segment resolution had a higher incidence of death (three of 34 [8.8%] versus zero of 76 [0%], P=0.0086), reinfarction (five of 34 [14.7%] versus two of 76 [2.6%], P=0.28) and revascularization (four of 34 [11.8%] versus three of 76 [3.9%], P=0.12). The combined end point (death, reinfarction and revascularization) was significantly lower in patients with ST segment resolution (P=0.03). CONCLUSIONS: Rapid ST segment resolution is associated with LV contractility recovery, and a better clinical outcome and prognosis after successful primary PTCA. Early DE after primary PTCA predicts LV functional recovery. Patients with ST segment resolution are likely to respond to early dobutamine testing.     

Suppression of fatty acid metabolism after exercise stress in patients with no electrocardiographic ST segment shift during balloon angioplasty.

Although ST segment shift is a marker of myocardial ischemia, some patients have no ST segment shift during percutaneous transluminal coronary angioplasty (PTCA). The aim of this study is to investigate myocardial perfusion and metabolism in adaptation for ischemia using 201TI and 123I-BMIPP dual exercise stress myocardial single photon emission computed tomography (SPECT) (dual stress SPECT). In 28 patients with coronary artery disease, dual stress SPECT was performed 3 weeks before PTCA. Early and delayed images were obtained at 5 minutes and at 3 hours after termination of ergometer stress, respectively. During PTCA, 12-lead ECG was recorded, and a significant ST segment shift was defined as more than 1 mm elevation or a depression of the J-point at the first ballooning. No collateral circulation on the coronary angiogram or 201TI filling on the delayed images were observed on any of the target regions of PTCA. Patients were divided into 2 groups: with (Group A: n = 15) and without (Group B: n = 13) significant ST segment shift during PTCA. A redistribution of TI was observed in 14 (93%) of Group A and 10 (77%) of Group B patients. Incidence of BMIPP redistribution was significantly higher in Group B (11 [85%]) than in Group A (3 [20%]) (p < 0.05). Redistribution of BMIPP means suppression of fatty acid metabolism during exercise stress. Augmentation of glucose metabolism is speculated to be an energy source in ischemic preconditioning.     

经皮冠状动脉腔内成形术中冠状动脉内心电图的应用研究

目的　探讨冠状动脉内心电图（ＩＣ－ＥＣＧ）在经皮冠状动脉腔内成形术（ＰＴＣＡ）术中的应用。方法对４４例冠心病病人的５１支冠状动脉行ＰＴＣＡ时记录ＩＣ－ＥＣＧ和体表ＥＣＧ,分析心绞痛组、心肌梗塞溶栓再通组、溶栓未通组ＩＣ－ＥＣＧ的缺血性心电图改变情况,并与体表监护导联ＥＣＧ相比较。结果９６．１％的血管行球囊扩张时ＩＣ－ＥＣＧ有缺血性改变;心绞痛组、心肌梗塞溶栓再通组及溶栓未通组的ＩＣ－ＥＣＧ的ＳＴ段上移程度有明显差别。结论ＩＣ－ＥＣＧ比体表ＥＣＧ在反映心肌缺血方面更敏感,ＰＴ－ＣＡ时ＩＣ－ＥＣＧ的ＳＴ段变化能一定程度地反映残余心肌的成活情况。     

Persistent ST-segment elevation after primary stenting for acute myocardial infarction: its relation to left ventricular recovery

BACKGROUND: Early restoration of coronary artery patency in acute myocardial infarction (AMI) has been linked to improvement in survival. However, early recanalization of an occluded epicardial coronary artery by either thrombolytic agents or percutaneous transluminal coronary angioplasty (PTCA) does not necessarily lead to left ventricular (LV) function recovery. HYPOTHESIS: The aim of this study was to evaluate the relation between persistent ST elevation shortly after primary stenting for acute myocardial infarction (AMI) and LV recovery. METHODS: Thirty-one patients with primary stenting for AMI were prospectively enrolled. To evaluate the extent of microvascular injury, serial ST-segment analysis on a 12-lead electrocardiogram recording just before and at the end of the coronary intervention was performed. Persistent ST-segment elevation (Persistent Group, n = 11) was defined as > or = 50% of peak ST elevation and resolution (Resolution Group, n = 20) was defined as < 50% of peak ST elevation. Echocardiography was performed on Day 1 and 3 months after primary stenting. RESULTS: At 3 months, infarct zone wall-motion score index (WMSI, 2.1 +/- 0.6 vs. 2.7 +/- 0.3, p < 0.05) was smaller in the Resolution Group than in the Persistent Group, whereas wall motion recovery index (RI, 0.4 +/- 0.3 vs. 0.1 +/- 0.2, p < 0.05) and ejection fraction (58 +/- 5 vs. 43 +/- 10%, p < 0.05) were larger in the Resolution Group than in the Persistent Group. The extent of persistent ST elevation (% ST) shortly after successful recanalization of the infarct-related artery was significantly related to RI at 3 months (r = -0.4, p < 0.05). However, time to reperfusion was not related to RI at 3 months. There was also significant correlation between corrected TIMI frame count and %ST (r = 0.4, p < 0.05). CONCLUSIONS: Persistent ST-segment elevation shortly after successful recanalization (> or = 50% of the peak value), as a marker of impaired microvascular reperfusion, predicts poor LV recovery 3 months after primary stenting for AMI.     

Comparative Prognostic Significance of Simultaneous Versus Independent Resolution of ST Segment Depression Relative to ST Segment Elevation During Acute Myocardial Infarction

Objectives. We sought to determine the prognostic significance of simultaneous versus independent resolution of ST segment depression that occurs concomitant with ST segment elevation during acute myocardial infarction (AMI).Background. ST segment depression in leads other than those showing ST segment elevation during AMI is a common phenomenon. Whether this indicates adverse outcomes remains controversial. We hypothesized that the timing of ST segment depression resolution relative to ST segment elevation resolution might differentiate between a high risk group and a low risk group of patients.Methods. Continuous 12-lead ST segment monitoring was performed after thrombolytic therapy for AMI in 413 patients, 261 of whom met technical criteria for analysis. Blinded analysis of ST segment depression resolution patterns was used to group patients as follows: 1) no ST segment depression at any time (control group); 2) ST segment depression resolving simultaneously with ST segment elevation (simultaneous group); and 3) ST segment depression persisting after ST segment elevation resolution (independent group). These patterns were correlated with the outcomes—recurrent angina, reinfarction, heart failure and death—using chi-square analysis and the Fisher exact test for categoric variables and the Wilcoxon rank-sum test for continuous variables.Results. The incidence of recurrent angina, reinfarction and heart failure was similar among the three groups. In-hospital mortality, however, was significantly higher in the independent group (13%) than either the simultaneous group (1%, p < 0.001) or the control group (0%, p = 0.002).Conclusions. Continuous analysis of ST segment resolution identifies, among patients with AMI with concomitantly occurring ST segment elevation and depression, a subgroup with increased in-hospital mortality. The pathogenic mechanism of increased mortality is not currently known.     

去纤酶对冠状动脉成形术后再狭窄和心脏负荷能力的影响

本研究旨在评价去纤酶对冠状动脉成形术 (PTCA)后再狭窄及心脏负荷能力的影响。方法 :142例PTCA术后患者随机进入去纤酶组 (n =70 )和肝素组 (n =72 ) ,术后分别用去纤酶及肝素治疗 ,分别于PTCA前、PTCA后 7～ 14天、3～ 6个月和 10～ 12个月进行心电图运动试验及核素心肌灌注显像负荷试验 ,可疑再狭窄者行冠状动脉造影。PTCA后 2组患者最大运动时间、心率指数、ST段缺血指数及心肌血流灌注均较PTCA前明显改善 ,但去纤酶组的改善程度较肝素组更显著 (P均 <0 .0 5)。去纤酶组及肝素组的再狭窄率分别为 11%和 2 1% (P >0 .0 5)。去纤酶能显著改善PTCA术后心肌血流灌注和心脏负荷能力 ,并具有降低再狭窄率的趋势