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Южно-Российский журнал терапевтической практики

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ЭЛЕКТРОКАРДИОГРАФИЧЕСКИЕ ПРИЗНАКИ ОСТРОЙ ИШЕМИИ МИОКАРДА КАК ЭКВИВАЛЕНТЫ ОСТРОГО КОРОНАРНОГО СИНДРОМА С ПОДЪЕМОМ СЕГМЕНТА ST

https://doi.org/10.21886/2712-8156-2020-1-1-43-49

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Аннотация

Ранняя реперфузия остается ключевым этапом ведения пациентов с острым коронарным синдромом с подъемом сегмента ST (ОКСпST), так как элевация на электрокардиограмме (ЭКГ) признана проявлением критического стеноза или окклюзии коронарной артерии. В то же время около 10 – 25 % пациентов с острым коронарным синдромом без подъема сегмента ST, по данным коронароангиографии (КАГ), также имеют критический стеноз или окклюзию крупной эпикардиальной артерии. Задержка реваскуляризации в таком случае закономерно приводит к ухудшению исходов. Хотя в текущих рекомендациях кратко упомянуты критерии эквивалентов ОКСпST, сведения по специфическим паттернам ЭКГ все еще недостаточны. Проведен поиск по базам данных MEDLINE и EMBASE, выполнен систематический обзор литературы по паттернам острого коронарного
синдрома без подъема ST (ОКСбпST), ассоциированным с критическим стенозом или окклюзией, также приведены  сведения по чувствительности и специфичности. Трудно переоценить практическую ценность выявления пациентов высокого риска в отсутствии подъема ST на ЭКГ на этапе скорой помощи или приемного покоя.


Об авторах

О. П. Ишевская
ФГБОУ ВО «Кубанский государственный медицинский университет» Минздрава России
Россия

ординатор по специальности «кардиология» кафедры Терапии №1 ФПК и ППС

Краснодар



А. М. Намитоков
ГБУЗ «Научно-исследовательский институт — Краевая клиническая больница № 1 им. профессора С.В. Очаповского» Минздрава Краснодарского края
Россия
к.м.н., заведующий кардиологическим отделением №2

Краснодар


Е. Д. Космачева
ФГБОУ ВО «Кубанский государственный медицинский университет» Минздрава России
Россия
д.м.н., зав. кафедрой Терапии №1 ФПК и ППС 

Краснодар


Список литературы

1. Ibanez B., James S., Agewall S., Antunes M.J., BucciarelliDucci C., Bueno H., et al. 2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation. European Heart Journal. 2018;39(2):119–177, DOI: 10.1093/eurheartj/ehx393.

2. Antman E.M., Anbe D.T., Armstrong P.W., Bates E.R., Green L.A., Hand M. et al. ACC/AHA guidelines for the management of patients with ST-elevation myocardial infarction. J Am CollCardiol. 2004;44(3):671-719. DOI: 10.1016/j.jacc.2004.07.002.

3. Khan A.R., Golwala H., Tripathi A., Bin Abdulhak A.A., Bavishi C., Riaz H. et al. Impact of total occlusion of culprit artery in acute non-ST elevation myocardial infarction: a systematic review and meta-analysis. European Heart Journal, 2017;38(41):3082–3089, DOI: 10.1093/eurheartj/ehx418.

4. Wall J., White L. D., Lee A. Novel ECG changes in acute coronary syndromes. Would improvement in the recognition of ‘STEMI-equivalents’ affect time until reperfusion?. Internal and emergency medicine. 2018;13(2):243-249. DOI: 10.1007/s11739-016-1595-3.

5. Thygesen K., Alpert J. S., Jaffe A. S., Chaitman B. R., Bax J. J., Morrow D. A. et al. Fourth universal definition of myocardial infarction (2018). Journal of the American College of Cardiology. 2018;72(18):2231-2264. DOI: 10.1016/j.jacc.2018.08.1038.

6. Nikus K., Pahlm O., Wagner G., Birnbaum Y., Cinca J., Clemmensen P. et al. Electrocardiographic classification of acute coronary syndromes: a review by a committee of the International Society for Holter and Non-Invasive Electrocardiology. Journal of electrocardiology. 2010;43(2): 91-103. DOI: 10.1016/j.jelectrocard.2009.07.009.

7. Bayés de Luna A. New heart wall terminology and new electrocardiographic classification of Q-wave myocardial infarction based on correlations with magnetic resonance imaging. Revistaespanola de cardiologia. 2007;60(7):683-689.DOI: 10.1016/S1885-5857(08)60002-X.

8. American Heart Association Writing Group on Myocardial Segmentation and Registration for Cardiac Imaging: Cerqueira M. D., Weissman N. J., Dilsizian V., Jacobs A. K., Kaul S., Verani M. S. et al. Standardized myocardial segmentation and nomenclature for tomographic imaging of the heart: a statement for healthcare professionals from the Cardiac Imaging Committee of the Council on Clinical Cardiology of the American Heart Association. Circulation. 2002;105(4):539-542. DOI: 10.1161/hc0402.102975.

9. Agarwal J. B., Khaw K., Aurignac F., LoCurto A. Importance of posterior chest leads in patients with suspected myocardial infarction, but nondiagnostic, routine 12-lead electrocardiogram. The American journal of cardiology. 1999;83(3):323-326. DOI: 10.1016/S0002-9149(98)00861-3.

10. Shah A., Wagner G. S., Green C. L., Crater S. W., Sawchak S. T., Wildermann N. M., et al. Electrocardiographic differentiation of the ST-segment depression of acute myocardial injury due to the left circumflex artery occlusion from that of myocardial ischemia of nonocclusive etiologies. The American journal of cardiology. 1997;80(4):512-513. DOI: 10.1016/s0002-9149(97)00406-2.

11. Dunn R.F., Newman H.N., Bernstein L., Harris P.J., Roubin G.S., Morris J., et al. The clinical features of isolated left circumflex coronary artery disease. Circulation. 1984;69(3):477–484. DOI: 10.1161/01.CIR.69.3.477.

12. Khan J.N., Chauhan A., Mozdiak E., Khan J.M., Varma C. Posterior myocardial infarction: are we failing to diagnose this? Emergency Medicine Journal. 2012;29(1):15-18. DOI: 10.1136/emj.2010.099861

13. Waldo S.W., Brenner D.A., Li S., Alexander K., Ganz P. Reperfusion times and in-hospital outcomes among patients with an isolated posterior myocardial infarction: insights from the National Cardiovascular Data Registry (NCDR). American heart journal. 2014;167(3):350-354. DOI: 10.1016/j.ahj.2013.11.011.

14. Nikus K. C., Eskola M. J., Virtanen V. K., Vikman S., Niemelä K. O., Huhtala H., et al. ST-depression with negative T waves in leads V4–V5—a marker of severe coronary artery disease in non-ST elevation acute coronary syndrome: a prospective study of angina at rest, with troponin, clinical, electrocardiographic, and angiographic correlation. Annals of noninvasive electrocardiology. 2004;9(3):207-214. DOI: 10.1111/j.1542-474X.2004.93545.x.

15. Genoni M., Tavakoli R., Hofer C., Bertel O., Turina M. Clopidogrel before urgent coronary artery bypass graft. Journal of thoracic and cardiovascular surgery. 2003;126(1):288-289. DOI: 10.1016/s0022-5223(03)00020-5

16. de Zwaan C., Bar F. W., Janssen J. H., Cheriex E. C., Dassen W. R., Brugada P., et al. Angiographic and clinical characteristics of patients with unstable angina showing an ECG pattern indicating critical narrowing of the proximal LAD coronary artery. American heart journal. 1989;117(3):657-665. DOI: 10.1016/0002-8703(89)90742-4

17. Wasserburger R.H., Corliss R.J. Prominent precordial T waves as an expression of coronary insufficiency. The American journal of cardiology. 1965;16(2):195-205. DOI: 10.1016/0002-9149(65)90474-1.

18. Noble R. J., Rothbaum D. A., Knoebel S. B., McHenry P. L.,nAnderson G. J. Normalization of abnormal T waves in ischemia. Archives of internal medicine. 1976;136(4):391-395. DOI: 10.1001/archinte.1976.03630040003002.

19. Haines D. E., Raabe D. S., Gundel W. D., Frans J. T. Anatomic and prognostic significance of new T-wave inversion in unstable angina. American Journal of Cardiology. 1983;52(1):14-18. DOI: 10.1016/0002-9149(83)90061-9.

20. Sgarbossa E. B., Meyer P. M., Pinski S. L., Pavlovic-Surjancev B., Barbagelata A., Goodman S.G. et al. Negative T waves shortly after ST-elevation acute myocardial infarction are a powerful marker for improved survival rate. American heart journal. 2000;140(3):385-394 .DOI: 10.1067/mhj.2000.108835.

21. deZwaan C., Bär F. W., Wellens H. J. Characteristic electrocardiographic pattern indicating a critical stenosis high in left anterior descending coronary artery in patients admitted because of impending myocardial infarction. American Heart Journal. 1982;103(4):730-736. DOI: 10.1016/0002-8703(82)90480-X.

22. Patel K., Alattar F., Koneru J., Shamoon F. ST-Elevation myocardial infarction after pharmacologic persantine stress test in a patient with Wellens’ syndrome. Case reports in emergency medicine. 2014;2014;530451. DOI: 10.1155/2014/530451.

23. Morris N.P., Body R. The De Winter ECG pattern: morphology and accuracy for diagnosing acute coronary occlusion: systematic review. European Journal of Emergency Medicine. 2017;24(4):236-242. DOI: 10.1097/MEJ.0000000000000463.

24. de Winter R. J., Verouden N. J., Wellens H. J., Wilde A. A. A new ECG sign of proximal LAD occlusion. New England Journal of Medicine. 2008;359(19):2071-2073. DOI: 10.1056/NEJMc0804737.

25. de Winter R. W., Adams R., Amoroso G., Appelman Y., ten Brinke L., Huybrechts B. et al. Prevalence of junctional ST-depression with tall symmetrical T-waves in a prehospital field triage system for STEMI patients. Journal of electrocardiology. 2019;52:1-5. DOI: 10.1016/j.jelectrocard.2018.10.092.

26. Zhao Y. T., Huang Y. S., Yi Z. de winters ECG changes and anterior myocardial infarction. QJM: An International Journal of Medicine. 2016;109(4):269-271. DOI: 10.1093/qjmed/hcv198.

27. Rao M. Y., Wang Y. L., Zhang G. R., Zhang Y., Liu T., Guo A. J. et al. Thrombolytic therapy to the patients with de Winter electrocardiographic pattern, is it right?. QJM: An International Journal of Medicine. 2018;111(2):125-127. DOI: 10.1093/qjmed/hcx253.

28. Kenigsberg D. N., Khanal S., Kowalski M., Krishnan S. C. Prolongation of the QTc interval is seen uniformly during early transmural ischemia. Journal of the American College of Cardiology. 2007;49(12):1299-1305.DOI: 10.1016/j.jacc.2006.11.035.

29. Smith F.M. The ligation of coronary arteries with electrocardiographic study. Archives of Internal Medicine. 1918;22(1):8-27. DOI: 10.1001/archinte.1918.00090120013002.

30. Somers M.P., Brady W.J., Perron A.D., Mattu A. The prominant T wave: electrocardiographic differential diagnosis. The American journal of emergency medicine. 2002;20(3):243-251. DOI: 10.1053/ajem.2002.32630.

31. Bayes D.L.A., Carreras F., Cladellas M., Oca F., Sagues F., Garcia M.M. Holter ECG study of the electrocardiographic phenomena in Prinzmetal angina attacks with emphasis on the study of ventricular arrhythmias. Journal of electrocardiology. 1985;18(3):267. DOI: 10.1016/s0022-0736(85)80051-0

32. Sclarovsky S., Mager A., Kusniec J., Rechavia E., Sagie A. Electrocardiographic classification of acute myocardial ischemia. Israel journal of medical sciences, 1990;26(9): 525-531. PMID: 2228566.

33. Birnbaum Y., Mahaffey K.W., Criger D.A., Gates K.B., Barbash G.I., Barbagelata A. et al. Grade III ischemia on presentation with acute myocardial infarction predicts rapid progression of necrosis and less myocardial salvage with thrombolysis. Cardiology. 2002;97(3):166-174. DOI: 10.1159/000063334.

34. Sagie A., Sclarovsky S., Strasberg B., Kracoff O., Rechavia E., Bassevich R., et al. Acute anterior wall myocardial infarction presenting with positive T waves and without ST segment shift: electrocardiographic features and angiographic correlation. Chest. 1989;95(6):1211-1215. DOI: 10.1378/chest.95.6.1211.

35. Collins M.S., Carter J.E., Dougherty J.M., Majercik S.M., Hodsden J.E., Logue E.E. Hyperacute T-wave criteria using computer ECG analysis. Annals of emergency medicine. 1990;19(2):114-120. DOI: 10.1016/S0196-0644(05)81792-5.

36. Manno B.V., Hakki A.H., Iskandrian A.S., Hare T. Significance of the upright T wave in precordial lead V1in adults with coronary artery disease. Journal of the American College of Cardiology. 1983;1(5):1213-1215. DOI: 10.1016/S0735-1097(83)80132-6.

37. de Luna A.B., Fiol-Sala, M. Electrocardiography in ischemic heart disease: clinical and imaging correlations and prognostic implications. John Wiley & Sons. 2008. ISBN: 978-1-4051-7362-9.

38. Erne P., Iglesias J.F., Urban P., Eberli F. R., Rickli H., Simon R. et al. Left bundle-branch block in patients with acute myocardial infarction: Presentation, treatment, and trends in outcome from 1997 to 2016 in routine clinical practice. American heart journal. 2017;184:106-113. DOI: 10.1016/j.ahj.2016.11.003.

39. Sgarbossa E.B., Pinski S L., Barbagelata A., Underwood D. A., Gates K. B., Topol E. J. et al. Electrocardiographic diagnosis of evolving acute myocardial infarction in the presence of left bundle-branch block. New England Journal of Medicine. 1996;334(8):481-487. DOI: 10.1056/NEJM199602223340801.

40. Smith S.W., Dodd K.W., Henry T.D., Dvorak D.M., Pearce L.A. Diagnosis of ST-elevation myocardial infarction in the presence of left bundle branch block with the ST-elevation to S-wave ratio in a modified Sgarbossa rule. Annals of emergency medicine. 2012;60(6):766-776. DOI: 10.1016/j.annemergmed.2012.07.119.

41. Meyers H.P., Limkakeng Jr A.T., Jaffa E.J., Patel A., Theiling B.J., Rezaie S.R. Validation of the modified Sgarbossa criteria for acute coronary occlusion in the setting of left bundle branch block: A retrospective case-control study. American heart journal. 2015;170(6):1255-1264. DOI: 10.1016/j.ahj.2015.09.005.

42. Bertel N., Witassek F., Puhan M., Erne P., Rickli H., Naegeli B. Management and outcome of patients with acute myocardial infarction presenting with pacemaker rhythm. International journal of cardiology. 2017;230:604-609. DOI: 10.1016/j.ijcard.2016.12.047.

43. Mitchell G.J., Dodd K., Zvosec D.L., Chen E., Hart M. A., Marshall J. P103: Performance characteristics of the modified Sgarbossa criteria for diagnosis of acute

44. coronary occlusion in emergency department patients with ventricular paced rhythm and symptoms of acute coronary syndrome. Canadian Journal of Emergency Medicine. 2018;20(S1):S93-S93. DOI: 10.1017/cem.2018.301.

45. Chatterjee K., Harris A., Davies G., Leatham A. Electrocardiographic changes subsequent to artificial ventricular depolarization. British heart journal. 1969;31(6):770. DOI: 10.1136/hrt.31.6.770.

46. Wang J., Luo H., Kong C., Dong S., Li J., Yu H. Prognostic value of new-onset right bundle-branch block in acute myocardial infarction patients: a systematic review and meta-analysis. PeerJ. 2018;6:e4497. DOI: 10.7717/peerj.4497.

47. Widimsky P., Roháč F., Štásek J., Kala P., Rokyta R., Kuzmanov B. Primary angioplasty in acute myocardial infarction with right bundle branch block: should new onset right bundle branch block be added to future guidelines as an indication for reperfusion therapy? European heart journal. 2012;33(1):86-95.DOI: 10.1093/eurheartj/ehr291.

48. Strauss D.G., Loring Z., Selvester R.H., Gerstenblith G., Tomaselli G., Weiss R.G. Right, but not left, bundle branch block is associated with large anteroseptal scar. Journal of the American College of Cardiology. 2013;62(11):959-967. DOI: 10.1016/j.jacc.2013.04.060.

49. Neumann J.T., Sörensen N.A., Rübsamen N., Ojeda F., Schäfer S., Keller T. Right bundle branch block in patients with suspected myocardial infarction. European Heart Journal: Acute Cardiovascular Care. 2019;8(2):161-166. DOI: 10.1177/2048872618809700.


Для цитирования:


Ишевская О.П., Намитоков А.М., Космачева Е.Д. ЭЛЕКТРОКАРДИОГРАФИЧЕСКИЕ ПРИЗНАКИ ОСТРОЙ ИШЕМИИ МИОКАРДА КАК ЭКВИВАЛЕНТЫ ОСТРОГО КОРОНАРНОГО СИНДРОМА С ПОДЪЕМОМ СЕГМЕНТА ST. Южно-Российский журнал терапевтической практики. 2020;1(1):43-49. https://doi.org/10.21886/2712-8156-2020-1-1-43-49

For citation:


Ishevskaia O.P., Namitokov A.M., Kosmacheva E.D. ELECTROCARDIOGRAPHIC SIGNS OF ACUTE MYOCARDIAL ISCHEMIA AS EQUIVALENTS OF ST ELEVATION MYOCARDIAL INFARCTION. South Russian Journal of Therapeutic Practice. 2020;1(1):43-49. (In Russ.) https://doi.org/10.21886/2712-8156-2020-1-1-43-49

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