运动诱发ST段抬高的意义

目的观察运动诱发心电图ST段抬高的无心肌梗死（MI）者6例，探讨其冠状动脉（冠脉）病变特点。方法对无MI而运动诱发心电图ST段抬高的患者进行静息心电图、运动试验及冠脉造影检查，运动试验采用Bruce方案。结果在3002例行运动试验检查者中，有6例未患MI而运动诱发心绞痛伴心电图ST段抬高，发生率为0．2％。相应导联ST段抬高0．1～0．6mV，停止运动后心绞痛症状消失，ST段恢复正常。6例中，1例冠状动脉正常；余5例冠脉均有严重狭窄（70％～95％），ST段抬高导联与缺血相关血管有良好的对应关系，近期内行冠脉介入治疗效果良好，术后症状消失。多次复查运动试验，结果均阴性。结论无MI者运动诱发心电图ST段抬高多提示心肌透壁缺血，冠脉病变重，应采取积极的治疗措施。

Clinical Signif Icance of Exercise-induced ST-segment Elevation in Patients without Previous Myocardial Infarction

Objective To study the lesion characters of coronary artery and optimal treatment of patients without previous myocardial infarction who developed an exercise - induced ST - segment elevation. Methods Six patients without previous myocardial infection who developed ST - segment elevation during exercise testing were underwent coronary angiography and rest electrocardiography, and modified Bruce protocol were used during exercise test. Results The incidence of exercise - induced ST - segment elevation was 0. 20% （6/3002）. ST - segment elevated 0. 1 -0. 6 mV in relevant leads during exercise testing. One of the 6 patients had a normal coronary artery. The others all had severe coronary stenosis （70% - 95% ）. There was a good correlation between leads of ST - segment elevation and related ischemic artery, and percutaneous coronary intervention （PCI） was safe and effective. Also, these patients showed no negative results of exercise testing after PCI. Conclusion The findings indicates that patients developed exercise - induced ST - segment elevation without no previous myocardial infarction often have severe coronary stenosis and PCI is safe and effective for these patients.