非ST段抬高急性冠状动脉综合征患者ST段压低程度与心脏事件

作     者：Savonitto S. Cohen M. G. Politi A. 马超 

作者机构：Dipartimento Cardio-toraco-vascolare‘ A. de Gasperis’ Ospedale Niguarda Ca' Granda Piazza Ospedale Maggiore 3 20162 Milan Italy 

出 版 物：《世界核心医学期刊文摘(心脏病学分册)》 (Digest of the World Core Medical Journals(Cardiology))

年 卷 期：2006年第3期

页      面：51-52页

学科分类：1002[医学-临床医学] 100201[医学-内科学(含：心血管病、血液病、呼吸系病、消化系病、内分泌与代谢病、肾病、风湿病、传染病)] 10[医学] 

主　　题：急性冠状动脉综合征 ST 心脏事件 程度 患者 

摘      要：Aims: We sought to determine whether the extent of myocardial ischaemia on the admission electrocardiogram(ECG) has independent predictive value for short-term risk stratification of patients with non-ST-segment elevation acute coronary syndromes(NSTE ACS). Although the presence of ischaemic ECG changes on admission has been shown to predict outcome, the relationship between the extent of ECG changes and the risk of cardiac events is still ill defined. Methods and results: We analysed the admission ECGs of 5192 ACS patients enrolled in the GUSTO-IIb trial, without an ECG indication for thrombolysis. ECG tracings showing one or more of the following were eligible: ST-segment depression 0.5 mm, T-wave inversion 1 mm, and ST-segment elevation 0.5 mm but 1 mm. ECG variables associated with unfavourable 30 day outcomes in a univariable analysis were further assessed in a multivariable logistic regression model including independent clinical predictors. In the multivariable clinical, enzymatic, and ECG model, the sum of ST-segment depression(in millimetres) in all leads was a powerful independent predictor of 30 day death(P 0.0001), with a continuous increase in risk with the extent of ST-segment depression. The sum of ST-segment depression(P 0.0001) and the presence of minimal inferior ST-segment elevation(P 0.0001) or anterior ST-segment elevation(P=0.0182) were also independent predictors of the composite of death and myocardial infarction or reinfarction. The extent of ST-segment depression showed a highly significant correlation with the prevalence of three-vessel(P 0.0001) or left main coronary disease(P 0.0001), and also with the peak levels of creatine kinase(P 0.0001) during the index episode of ACS. Conclusion: In patients with NSTE ACS, the sum of ST segment depression in all ECG leads is a powerful predictor of all-cause mortality at 30 days, independent of clinical variables and correlates with the extent and severity of coronary artery disease. The