| Objective To investigate clinical significance of the grade of ischemia by QRS complex on the admission electrocardiogram(ECG) in patients with acute ST-segment elevation myocardial infarction(STEMI).Methods The enrollments were taken from the patients with ST-elevation acute myocardial infarction hospitalized in Emergency Department and Cardiology hospitalization at the Second Hospital of Hebei Medical University during 2006-2009. In line with "2004 ACC / AHA recommendation of acute myocardial infarction diagnosis and treatment guidelines" in the diagnostic criteria for AMI, all patients were classified according to Birnbaum's ischemia grading criteria ( grade 1 ischemia: the tall T waves, symmetrical, and peaked; grade 2 ischemia: ST elevation is not associated with terminal QRS distortion waves; grade 3 ischemia: In addition to ST-segment elevation addition, QRS wave terminal R wave of the Ministry of twisted and often accompanied by increased and the S wave disappeared); exclusion criteria: (1) There was an old myocardial infarction in the past years.(2) Other causes of cardiac dysfunction. (3) bundle branch block those. (4) ECG data insufficiency.A total of 269 cases, including two groups, one is non-thrombolytic group the other one is thrombolytic group .there were 105 cases in non-thrombolytic group including grade 2 ischemia 56 cases and grade 3 ischemic 49 cases; 164 cases were thrombolytic reperfusion therapy for the thrombolytic group, comprising grade 2 ischemia 102 cases, 62 cases of grade 3 ischemia.MethodologyDelivery Method At frist all patients were treated with chewed enteric-coated aspirin 300mg, clopidogrel 300 mg, and heparin anticoagulation, while giving statins lipid-lowering drugs,βblockers, angiotensin-converting enzyme inhibitors, as well as nitrates. In thrombolytic group patients were treated with Alteplase 50mg(dissolved, the concentration of 1mg/ml)(instructions: first 8mg intravenous injection, then the remaining 42mg intravenous drip within 90min). And then patients were treatment with heparin 1000U / h intravenous drip or micro-pump pump 48h, while monitoring the activated partial thromboplastin time (APTT) and adjust the heparin dose to maintain APTT at 2.0 times the normal value of 1.5 ~ (50 ~ 70s ), 48h later the instructions changed to subcutaneous low molecular weight heparin 5000U, once every 12h.The patients's electrocardiograms were done and analyzed by two investigator who knew nothing detailed about the clinical data.ST-Segment elevation range(∑ST) with ST-segment elevation biggest lead of the subject.ST Segment Resolution (STR): In the two hours after thrombolysis, ST segment elevation measuring the sharpest lead to ST segment depression as much as 50% or more means reperfusion success. 2 weeks after infarction patients were checked with ultrasound echocardiography to measure left ventricular ejection fraction, wall motion observed the situation by two specialized physicians who were unaware of the clinical data. And 2 weeks after AMI use line resting 99mTc-MIBI myocardial perfusion SPECT imaging to measure radioactivity defect area.Detection of CTNI,CKmB during hospitalization and observe the ECG changes, arrhythmia (ventricular tachycardia or fibrillation, bradycardia, or atrioventricular block), heart failure or cardiogenic shock, the incidence of re-infarction and in-patient mortality. SPSS16.0 statistical processing applications software was used for statistical analysis. p<0.05 for the difference was significant.Results:There were no difference between the patients of thrombolysis group in sex, age, infarct site, hypertension, hyperlipidemia, diabetes ,preinfarction angina, etc.So was non-thrombolytic group. 1 ECGIn the non-thrombolytic group ST-segment elevation (∑ST) (mV) of the patients with grade 3 ischemia were significantly greater than that of grade 2 ischemia group (p <0.05).In thrombolytic group patients with grade 3 ischemia had greaterΣST on admission and 2h after thrombolysis ECGs(p<0.01), the incidence rate of STR in patients with grade 3 ischemia was lower than that in patients with grade 2 ischemia((p <0.01)myocardial injury and infarct size2.Ischemic infarct sizeThe patients with grade 3 ischemia had a higher peak of creatine kinase MB isoenzyme (U / L) (P <0.05) and CTNI peak (ng / ml) (P <0.05) than that of grade 2 ischemia group in the non-thrombolytic group .so did in thrombolytic group. Non-thrombolytic group and the thrombolytic group 3 patients with ischemic infarct size was significantly larger than the 2 ischemic patients (p <0.05).3.Cardiac function and hospital complicationsLeft ventricular ejection fraction of the patients with grade 3 ischemia group was lower than that of the 2 ischemic group (p <0.05) in non-thrombolytic group. so did thrombolytic group(p <0.05).In thrombolytic group, there was no significant difference on the incidence of serious arrhythmia (p> 0.05), heart failure or cardiogenic shock, and the incidence (p> 0.05), re-infarction (p>0.05) the mortality (p>0.05)between the grade 3 ischemia group and the grade 2 ischemia group, and there was higher trends of the 3 ischemia group than that of the 2 ischemic group. aneurysm incidence of the patients with grade 3 ischemia was higher than that of grade 2 ischemia(p >0.05).In non-thrombolytic group both grade 3 ischemia and 2 ischemic patients in the incidence of serious arrhythmia (p <0.05), heart failure or cardiogenic shock, the incidence (p <0.05), mortality rate (p<0.05), aneurysm incidence rate (p<0.05) have a significant difference. The grade 3 ischemia is higher than the grade 2 ischemia (p<0.05). There was no significant difference (p<0.05)in re-infarction rate between grade 3 ischemia group and grade 2 ischemia groupConclusion1. The patients with grade 3 ischemia have larger final infarct size, worse cardiac function, and more hospitalized complications than that of the patients with grade 2 ischemia in non-thrombolytic group2. Patients with grade 3 ischemia treated by thrombolytic therapy had significantly lower recanalization rate and significantly greater myocardial infarct size than that of grade 2 ischemia group and had higher trend hospitalized complications comparing with grade 2 ischemia group .3. On admission electrocardiogram showed that grade 3 Ischemia indicate larger area of myocardial infarction, worse cardiac function and poor prognosis , we should as soon as possible take effective reperfusion therapy in patients with grade 3 ischemia on admission ECG patients to improve the prognosis of patients .
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