Prognostic Value Seen in Continuous ST-Segment Monitoring in ACS
连续ST段监测在急性冠脉综合征中的预测价值
NEW YORK (Reuters Health) May 10 - Continuous ST-segment monitoring during the first 48 hours in patients with non-ST-elevation acute coronary syndrome (ACS) provides long-term prognostic information independent of comprehensive risk assessment on presentation. This may help identify high-risk patients who benefit from early revascularization, researcher say.
据纽约路透社健康5月10日讯，在发生无ST段抬高的急性冠脉综合征病人发病后的第一个48小时内，连续的ST段监测提供了长期的预后信息，而且这些信息不依赖于对病人表现的综合危险率的评估。
"In patients with acute coronary syndromes, recurrent ischemia detected by continuous electrocardiographic monitoring portends a poor outcome," Dr. Shaun G. Goodman, of the University of Toronto, Ontario, Canada, and colleagues write in the April issue of the American Heart Journal.
“在急性冠脉综合征病人中，连续心电图监测出现再发局部缺血预后不良，”加拿大安大略省多伦多大学Goodman医生和他的同事在4月出版的美国心脏杂志上写到。
In their study, the researchers examined the additional long-term prognostic value of continuous ST-segment monitoring beyond the Global Registry of Acute Coronary Events (GRACE) risk score, a validated predictor of in-hospital mortality, in ACS.
急性冠脉事件全面登记(GRACE)的危险分数是急性冠脉综合征病人死亡率的有效预测指标，在这个实验中，研究者检查了在(GRACE)之外，连续ST段监测额外的长期预后价值。
The researchers determined the GRACE risk score in 681 non-ST-elevation ACS patients enrolled in a treatment trial. Components of the GRACE risk score include age, admission heart rate, systolic blood pressure, Killip class, cardiac arrest, ST-segment deviation on ECG, serum creatinine, and cardiac biomarker status.
研究者检查了治疗实验中681名无ST段抬高的急性冠脉综合征病人的GRACE危险分数。GRACE危险分数的构成包括年龄，入院心率，收缩压，Killip分级，心脏停搏，心电图上ST段移位，血清肌酸酐和心脏生物标记状况。
An automated algorithm was used to analyze continuous ST-segment monitoring in the first 48 hours.
他们用自动化算法来分析第一个48小时内连续ST段监测的结果。
The subjects had a median GRACE risk score of 115. ST-segment shifts were present in 19.1% of the patients during the first 48 hours. GRACE risk scores were 129 in patients with ST-segment shifts, compared with 113 in patients without ST-segment shifts (p < 0.001).
受试者的平均GRACE危险分数是115。19.1%的病人在第一个48小时内出现ST段移位。有ST段移位的病人GRACE危险分数是129，无ST段移位的病人GRACE危险分数是113(p < 0.001)。
Patients were followed for a median of 30 months. The cumulative mortality rate during follow-up was 8.1%, and the incidence of the composite end point of death or nonfatal (re-)MI was 13.7%.
病人平均随访30个月。随访中的累计死亡率是8.1%，死亡或非致死性心肌缺血等相反终止事件的发生率是13.7%.
Overall, 17.7% of patients with ST-segment shifts died during follow-up, compared with 5.8% of those without (p < 0.001). Patients with ST-segment shifts were also more likely to reach the composite end point (24.6% versus 11.1%, p < 0.001).
总而言之，ST段移位的病人在随访中死亡17.7%，无ST段移位的病人在随访中死亡5.8%(p < 0.001). ST段移位的病人更有可能触发相反终止事件(24.6%对11.1%, p < 0.001).
Multivariable analysis adjusting for GRACE risk score demonstrated that the presence of ST-segment shifts remained an independent predictor of death (adjusted hazard ratio [HR] = 2.37, p = 0.002) and death/MI (adjusted HR = 1.93, p = 0.003).
对GRACE危险分数的多变量分析校正证实了：ST段移位的存在是死亡（校正危害比 HR= 2.37, p = 0.002）和死亡/心肌缺血(校正危害比HR = 1.93, p = 0.003)的独立的预测指标。
Early continuous monitoring provides useful long-term prognostic information, Dr. Goodman and colleagues conclude, saying, "More widespread utilization of this valuable noninvasive risk stratification tool should be considered in the routine management of ACS."
Goodman医生和他的同事得出结论：早期连续检测提供了有效的长期预后信息，在急性冠脉综合症的常规治疗中，这个有价值的非侵入性风险分层工具将被广泛应用，
Am Heart J 2007;153:500-506.
美国心脏杂志2007;153:500-506.
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编译：
连续ST段监测在急性冠脉综合征中的预测价值
据纽约路透社健康5月10日讯，在发生无ST段抬高的急性冠脉综合征病人发病后的第一个48小时内，连续的ST段监测提供了长期的预后信息，而且这些信息不依赖于对病人表现的综合危险率的评估。加拿大安大略省多伦多大学Goodman医生和他的同事在4月出版的美国心脏杂志上写到：“在急性冠脉综合征病人中，连续心电图监测出现再发局部缺血预后不良。”急性冠脉事件全面登记(GRACE)的危险分数是急性冠脉综合征病人死亡率的有效预测指标，它包括年龄，入院心率，收缩压，Killip分级，心脏停搏，心电图上ST段移位，血清肌酸酐和心脏生物标记状况。在这个实验中，他们通过检查治疗实验中681名无ST段抬高的急性冠脉综合征病人的GRACE危险分数，来判定在(GRACE)之外，连续ST段监测额外的长期预后价值。他们用自动化算法来分析第一个48小时内连续ST段监测的结果。发现：受试者的平均GRACE危险分数是115。19.1%的病人在第一个48小时内出现ST段移位。有ST段移位的病人GRACE危险分数是129，无ST段移位的病人GRACE危险分数是113(p < 0.001)。病人平均随访30个月。随访中的累计死亡率是8.1%，死亡或非致死性心肌缺血等相反终止事件的发生率是13.7%。ST段移位的病人在随访中死亡17.7%，无ST段移位的病人在随访中死亡5.8%(p < 0.001). ST段移位的病人更有可能触发相反终止事件(24.6%对11.1%, p < 0.001).对GRACE危险分数的多变量分析校正证实了：ST段移位的存在是死亡（校正危害比 HR= 2.37, p = 0.002）和死亡/心肌缺血(校正危害比HR = 1.93, p = 0.003)的独立的预测指标。因此，Goodman医生和他的同事得出结论：早期连续ST段检测提供了有效的长期预后信息，在急性冠脉综合症的常规治疗中，这个有价值的非侵入性风险分层工具将被广泛应用，
PS:
Global Registry of Acute Coronary Events (GRACE)
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