Background

The importance of the grade of ischemia (GI) ECG classification in the risk assessment of patients with STEMI has been shown previously. Grade 3 ischemia (G3I) is defined as ST-elevation with distortion of the terminal portion of the QRS complex in two or more adjacent leads, while Grade 2 ischemia (G2I) is defined as ST-elevation without QRS distortion. Our aim was to evaluate the prognostic impact of the GI classification on the outcome in patients with STEMI.

Methods

7,211 patients from the TOTAL trial were included in our study. The primary outcome was a composite of cardiovascular death, recurrent myocardial infarction (MI), cardiogenic shock, or New York Heart Association (NYHA) class IV heart failure within one year.

Results

The primary outcome occurred in 153 of 1,563 patients (9.8%) in the G3I group vs. 364 of 5,648 patients (6.4%) in the G2I group (adjusted HR 1.27; 95% CI, 1.04 - 1.55; p=0.022). The rate of cardiovascular death (4.8% vs. 2.5%; adjusted HR 1.48; 95% CI 1.09 - 2.00; p=0.013) was also higher in patients with G3I.

Conclusions

G3I in the presenting ECG was associated with an increased rate of the composite of cardiovascular death, recurrent MI, cardiogenic shock, or NYHA class IV heart failure within one year compared to patients with G2I. Patients with G3I also had a higher cardiovascular death compared to patients with G2I.

中文翻译：

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ST 段抬高型心肌梗死患者心电图缺血分级的预后意义：直接 PCI 伴或不伴常规手动取栓的随机试验的子研究（TOTAL 试验）

背景

缺血 (GI) 心电图分级在 STEMI 患者风险评估中的重要性之前已经表明。3 级缺血 (G3I) 定义为 ST 段抬高，两个或多个相邻导联的 QRS 波群终末部分扭曲，而 2 级缺血 (G2I) 定义为 ST 段抬高，但没有 QRS 扭曲。我们的目的是评估 GI 分类对 STEMI 患者预后的影响。

方法

我们的研究包括来自 TOTAL 试验的 7,211 名患者。主要结局是一年内心血管死亡、复发性心肌梗塞 (MI)、心源性休克或纽约心脏协会 (NYHA) IV 级心力衰竭的复合结局。

结果

主要结果发生在 G3I 组 1,563 名患者中的 153 名 (9.8%) 与 G2I 组中 5,648 名患者中的 364 名 (6.4%)（调整后的 HR 1.27；95% CI，1.04 - 1.55；p=0.022）。G3I 患者的心血管死亡率（4.8% 与 2.5%；调整后 HR 1.48；95% CI 1.09 - 2.00；p=0.013）也更高。

结论

与 G2I 患者相比，目前 ECG 中的 G3I 与一年内心血管死亡、复发性 MI、心源性休克或 NYHA IV 级心力衰竭的复合发生率增加有关。与 G2I 患者相比，G3I 患者的心血管死亡率也更高。