对应导联ST段压低在急性ST段抬高心肌梗死患者中的临床价值

目的探讨对应导联ST段压低(reciprocal ST-segment depression,RSTD)在急性ST段抬高心肌梗死(acute ST-elevationmyocardial infarction,STEMI)患者中的临床重要性。方法选取2011年1月至2012年1月共318例STEMI并接受经皮冠状动脉造影(coronary artery angiography,CAG)的患者。根据入院时第1份心电图(electrocardiogram,ECG)是否出现RSTD,将患者分为RSTD组和非RSTD组,评价2组患者基线情况和CAG等结果。结果急性下壁心肌梗死在RSTD组中更常见。RSTD组较非RSTD组患者的收缩压(systolic blood pressure,SBP)和左室射血分数(left ventricular ejection fraction,LVEF)更低、Killip分级更高、肌酸激酶同工酶(creatinekinase-MB,CK-MB)和肌钙蛋白I(troponin I,TnI)的峰值更高、ST段抬高程度更高、合并心房纤颤、传导阻滞和心源性休克的概率更大、多支病变更常见、主动脉内球囊反搏术(intra-aortic balloon pump,IABP)的使用率更高、而且院内病死率更高(P<0.05)。结论伴RSTD的STEMI患者存在不稳定的血流动力学状态,且预后不佳。ECG可以较好地区分高危患者,从而指导治疗方案。

Clinical value of reciprocal ST-segment depression in patients with acute ST-segment elevation myocardial infarction

Objective To evaluate clinical value of reciprocal ST-segment depression(RSTD) in patients with acute ST-segment elevation myocardial infarction(STEMI). Methods Data of a total of 318 patients with STEMI and undergoing percutaneous coronary artery angiography(CAG) were collected from January 2011 to January 2012. According to whether there was RSTD on the admission electrocardiogram(ECG), the patients were divided into RSTD group and non-RSTD group. All patients were investigated and evaluated for baseline characteristics and results of coronary artery angiography(CAG). Results The acute inferior myocardial infarction was more common in RSTD group. The patients exhibiting RSTD tended to have a lower systolic blood pressure(SBP), poorer left ventricular ejection fraction(LVEF), higher Killip classification, higher peak creatinekinase-MB(CK-MB) and troponin I(TnI), higher degree of ST segment elevation, higher incidence of atrial fibrillation, conduction block and cardiogenic shock, more multi-vessel diseases, the higher utilization rate of intra-aortic balloon pump(IABP) and the higher in-hospital mortality(P<0.05). Conclusion The STEMI patients with RSTD were in unstable hemodynamic status and had worse prognosis. ECG could be good to identify the high-risk patients, and to choose treatment options.