早期ST段恢复对急性前壁心肌梗死预后的影响

The influence of early ST resolution on clinical outcome in acute myocardial infarction

目的 通过分析ST段抬高的急性前壁心肌梗死治疗后的临床预后,评价ST段的早期恢复程度反映心肌水平再灌注治疗的价值.方法 选择46例初发ST段抬高的急性前壁心肌梗死患者,选择心前导联中ST段抬高最显著的单个导联,测量治疗后ST段下降的最大比率（ST resolution,STR）[1],根据治疗后ST段下降的幅度分成ST段完全恢复（STR≥70%）或明显恢复（70%＞STR≥50%）组（A组）,ST段无恢复（STR＜50%）组（B组）,分别观察两组的临床预后.结果 A组26例,出现心功能Killip Ⅲ～Ⅳ级的1例,住院30 d内主要心脏不良事件（心源性休克、急性左心衰、死亡、恶性心律失常、再梗死）1例.随访中发现左室扩大5例,心力衰竭再入院1例.B组20例,出现心功能Killip Ⅲ～Ⅳ级的10例,住院30 d内主要心脏不良事件10例,随访中发现左室扩大10例,心力衰竭再入院5例.2组间存在明显差别.结论 急性心肌梗死治疗后早期ST段的下降幅度（STR≥50%）可作为反映心肌水平再灌注治疗的较好指标.

Objective To analyze the relationship between the early ST resolution and clinical outcome of anterior wall AMI. Methods A total of 46 patients with AM1 were divided into two groups according to the ST resolution. Clinical outcomes were compared between group A（n= 26,STR≥50%）and group B（n= 20,STR〈50%）. Results There were fewer patients with Killip Ⅱ and Ⅳ in group A than in group B. The incidence of in-hospital MACE was significantly lower in group A than in group B. The incidence of left ventricular enlargement and dysfunction were also higher in group A than in group B. Conclusion Early ST resolution after myocardial reperfusion represents improvement of myocardial perfusion and is related to a favorable outcome in anterior wall AMI