非ST段抬高心肌梗死病人伴或不伴ST段下降的临床特点和意义

Clinical Character and Significance of ST Segment Depression in Non-ST Elevation Acute Myocardial Infarction

目的:研究在非ST段抬高心肌梗死(NSTEMI)病人中伴或不伴ST段下降的临床特点和意义并行早期危险分层。方法:128名NSTEMI血病人根据入院时心电图(ECG)相邻2个导联伴或不伴ST段下降分为2组:ST段下降<1mm组(Ⅰ组)和ST段下降≥1mm组(Ⅱ组),分析比较2组间各种临床指标的差异及冠状动脉造影(CAG)的结果。结果:在两组间病人基本临床特点中,Ⅱ组病人的糖尿病发病率及血浆中心肌肌钙蛋白互Ⅰ(cTNI)的峰值显著高于Ⅰ组[26168 vs 13/60;(19.6±15.4)vs(11.6±6.9),P<0.05];在CAG检查中,Ⅱ组病人中冠状动脉三支及友主干病变的比率显著高于Ⅰ组(26/44 vs 10/38,P<0.005);心动超声检查左室功能(LVEF)Ⅱ组显著低于 Ⅰ组[(51.9±10.5)vs(64.2±8.6),P<0.05]。结论:在NSTEMI病人中,ECG上伴有ST段下降3≥1mm,表明多合并有糖尿病和冠状动脉多支血管病变,存在有心肌广泛及严重缺血,致心功能下降,预后不良。

Objective: To study the clinical Character and Significance of ST Segment Depression in Non--ST Elevation Acute Myocardial Infarction. Methods: According to if presence ST segment depression in two contiguous leads on the hospital admission electrocardiogram (ECG),the 126 patients were divided into the two groups: group Ⅰ(ST segment depression<1mm) and group Ⅱ(ST segment depression≥1mm in two contiguous leads). The baseline characters, creatine kinase isozyme (CK--MB), cardiac tropin (cTNI), cardiac function (LVEF) and coronary angiogram (CAG) were determined and compared. Results: There are no significance in the baseline character between the two groups, but the percentages of diabetes mellitus and value of car- diac tropin (cTNI) in the group Ⅱ are higher than the group Ⅰ[26/68 vs 13/60; (19.6±15.4) vs (11. 6±6.9), P<0.05]; The group Ⅱ have lower left ventricular ejection fraction[LVEF, (51.9±10.5) vs(64.2±8.6),P<0.05] and have more 3--vessel and lef main dis- ease in CAG than the gnup Ⅰ(26/44 vs 10/38,P<0.005). Conclusions: For the NSTEMI patients, ST segment depression≥1mm is associated with severe ischemia and multivessel coronary artery disease and left ventricular dysfunction, indicate the patients of ST segment depression≥1mm have a poor prognosis.