Aims: In patients with ST-elevation myocardial infarction(STEMI) scheduled for primary percutaneous coronary intervention(primary PCI), acute risk-assessment may be valuable for tailoring of adjunctive therapy at the ...Aims: In patients with ST-elevation myocardial infarction(STEMI) scheduled for primary percutaneous coronary intervention(primary PCI), acute risk-assessment may be valuable for tailoring of adjunctive therapy at the time of coronary intervention. The present study was designed to quantify pre-, per-, and post-interventional ST-changes, to evaluate whether a pre-specified continuous ST-monitoring classification provides potential prognostic information in the pre- and per-interventional phase, and to compare post-interventional ST-resolution parameters derived from continuous ST-monitoring and snapshot ECGs, respectively. Methods and results: In 92 STEMI patients, continuous ST-monitoring was initiated in the prehospital phase and continued during and 90 min following PCI. Patients were divided into three groups:(A) patients achieving spontaneous ST-resolution before PCI;(B) patients with preserved ST-elevation immediately before PCI and with no increase in ST-elevation during PCI; and(C) patients with preserved ST-elevation immediately before PCI and with increase in ST-elevation during PCI. Groups A(n=22), B(n=43), and C(n=27) differed in peak level of troponin-T(1.4, 4.7, and 7.2 μ g/L, P < 0.001), creatinine kinase MB isoenzyme(35, 150, and 325 μ g/L, P < 0.001), and N-terminal pro-brain natriuretic peptide(Nt-pro-BNP)(183, 175, and 269 pmol/L, P=0.084) during admission, and left ventricular ejection fraction evaluated within 2 h of PCI(0.53, 0.48, and 0.45, P=0.047) and after 3 months(0.58, 0.54, and 0.45, P < 0.001). Groups B and C also differed in time from first balloon inflation to ≥ 70% resolution of ST-elevation(14 vs. 42 min, P=0.002), whereas no differences were observed in traditional 90 min ST-resolution analysis or angiographically assessed parameters. Conclusion: STEMI patients transferred for primary PCI are heterogeneous with respect to pre- and per-interventional ST-changes, and a pre-specified ST-monitoring classification seems useful for stratification of patients at time of PCI into groups with low, intermediate, and high risk profile. Furthermore, post-interventional ST-monitoring indicates that traditional 90 min ST-resolution analysis may have limited value in the era of primary PCI.展开更多
文摘临床对于心肌缺血的观察主要通过患者主诉及12导联心电图(ECG)ST段的变化进行监测。但研究[1-2]发现,80%~90%的缺血事件为无症状的缺血,患者往往没有胸痛等症状,而标准12导联心电图只能提供大约10 s的数据,不能进行连续监测。美国心脏协会(American heart association,AHA)和美国心血管护理学会(American college of cardiovascular nursing,ACCN)在2004年首先推荐应用监护仪对急性冠脉综合征(Acute coronary syndrome,ACS)患者进行连续ST段监测,ACCN于2008年建议对所有重症患者应用连续ST段监测,即无论是否有心脏疾病,重症患者都应进行监测,尤其是处于不稳定的患者[3-4]。
文摘Aims: In patients with ST-elevation myocardial infarction(STEMI) scheduled for primary percutaneous coronary intervention(primary PCI), acute risk-assessment may be valuable for tailoring of adjunctive therapy at the time of coronary intervention. The present study was designed to quantify pre-, per-, and post-interventional ST-changes, to evaluate whether a pre-specified continuous ST-monitoring classification provides potential prognostic information in the pre- and per-interventional phase, and to compare post-interventional ST-resolution parameters derived from continuous ST-monitoring and snapshot ECGs, respectively. Methods and results: In 92 STEMI patients, continuous ST-monitoring was initiated in the prehospital phase and continued during and 90 min following PCI. Patients were divided into three groups:(A) patients achieving spontaneous ST-resolution before PCI;(B) patients with preserved ST-elevation immediately before PCI and with no increase in ST-elevation during PCI; and(C) patients with preserved ST-elevation immediately before PCI and with increase in ST-elevation during PCI. Groups A(n=22), B(n=43), and C(n=27) differed in peak level of troponin-T(1.4, 4.7, and 7.2 μ g/L, P < 0.001), creatinine kinase MB isoenzyme(35, 150, and 325 μ g/L, P < 0.001), and N-terminal pro-brain natriuretic peptide(Nt-pro-BNP)(183, 175, and 269 pmol/L, P=0.084) during admission, and left ventricular ejection fraction evaluated within 2 h of PCI(0.53, 0.48, and 0.45, P=0.047) and after 3 months(0.58, 0.54, and 0.45, P < 0.001). Groups B and C also differed in time from first balloon inflation to ≥ 70% resolution of ST-elevation(14 vs. 42 min, P=0.002), whereas no differences were observed in traditional 90 min ST-resolution analysis or angiographically assessed parameters. Conclusion: STEMI patients transferred for primary PCI are heterogeneous with respect to pre- and per-interventional ST-changes, and a pre-specified ST-monitoring classification seems useful for stratification of patients at time of PCI into groups with low, intermediate, and high risk profile. Furthermore, post-interventional ST-monitoring indicates that traditional 90 min ST-resolution analysis may have limited value in the era of primary PCI.
