心电图缺血分级与急性心肌梗死患者靶血管定位及预后的关系

Correlations of ECG ischemia classification and target vessel location and prognosis in patients with acute myocardial infarction

目的:探讨心电图缺血分级与急性心肌梗死(AMI)患者靶血管定位及预后的关系。方法:回顾性分析2020年9月至2022年9月该院收治的80例AMI患者的临床资料,根据Birnbaum心电图缺血分级结果将其分为二级缺血组50例和三级缺血组30例。比较两组血清肌酸激酶同工酶(CK-MB)、心肌肌钙蛋白I(cTnI)、B型脑钠肽(BNP)基线水平和升高幅度,靶血管定位和靶病变数量,以及随访6个月的主要心脏不良事件(MACE)发生率。结果:三级缺血组血清CK-MB、cTnI及BNP的基线水平和升高幅度均高于二级缺血组,差异有统计学意义(P<0.05);三级缺血组左前降支病变占比和靶病变数量均高于二级缺血组,左回旋支病变占比低于二级缺血组,差异有统计学意义(P<0.05);两组左主干、左主干分叉、右冠状动脉及右冠状动脉分支病变占比比较,差异均无统计学意义(P>0.05);三级缺血组MACE发生率为23.33%(7/30),高于二级缺血组的4.00%(2/50),差异有统计学意义(P<0.05)。结论:心电图二级缺血与三级缺血AMI患者的血清CK-MB、cTnI、BNP水平,靶血管定位,以及MACE发生率存在差异,心电图缺血分级可为医师判断AMI患者靶血管定位及改善预后提供指导。

Objective:To investigate correlations of ECG ischemia classification and target vessel location and prognosis in patients with acute myocardial infarction(AMI).Methods:The clinical data of 80 patients with AMI admitted to this hospital from September 2020 to September 2022 were retrospectively analyzed.According to the results of Birnbaum ECG ischemia classification,they were divided into secondary ischemia group(50 cases)and tertiary ischemia group(30 cases).The baseline levels and the increase of serum creatine kinase isoenzyme(CK-MB),cardiac troponin I(cTnI)and brain natriuretic peptide(BNP),the target vessel location,the number of target lesions,and the incidence of major adverse cardiac events(MACE)at 6 months of follow-up were compared between the two groups.Results:The baseline values and the increase of serum CK-MB,cTnI and BNP in the tertiary ischemia group were higher than those in the secondary ischemia group,and the differences were statistically significant(P<0.05).The proportion of left anterior descending artery lesions and the number of target lesions in the tertiary ischemia group were higher than those in the secondary ischemia group,the proportion of left circumflex artery lesions was lower than that in the secondary ischemia group,and the differences were statistically significant(P<0.05).There were no significant differences in the proportions of left main,left main bifurcation,right coronary artery and right coronary artery branch lesions between the two groups(P>0.05).The incidence of MACE in the tertiary ischemia group was 23.33%(7/30),which was higher than 4.00%(2/50)in the secondary ischemia group,and the difference was statistically significant(P<0.05).Conclusions:There are differences in the serum CK-MB,cTnI and BNP levels,the target vessel localization and the MACE incidence among the patients with secondary ischemia and tertiary ischemia AMI.ECG ischemia classification can provide a guidance for the physicians to determine the target vessel location and improve the prognosis in the patients with AMI.