再灌注治疗早期单导联ST段抬高峰值与T波倒置时间共同预测急性心肌梗死患者近期预后

Predicting outcome after reperfusion therapy in acute myocardial infarction according to ST-segment resolution and early T wave inversion

目的 评价再灌注治疗后ST段恢复的不同测量方法及早期T波倒置对急性ST段抬高心肌梗死 (STEMI)患者近期临床的预测价值 ,以期更简便快速识别高危患者。方法 2 6 8例STEMI患者 ,行直接经皮冠状动脉成形术开通梗死相关血管 ,观察术前、术后即刻、术后 1h单导联ST段抬高峰值及ST段抬高总和以及与术前比较ST段恢复百分比 ,动态观察心电图 ,记录T波倒置的时间点 ,观察住院期间死亡及复合终点事件 (包括死亡、再梗死、心衰、反复缺血发作、严重室性心律失常 )。结果 术后 1h单导联ST段抬高峰值是住院期间复合终点事件最强的预测因子 ,术后 1hST段抬高总和对预测住院期间死亡有较高价值。T波倒置时间及发病至球囊开通时间均是预测死亡独立的因素。进一步强调尽快开通血管的重要性。结论 术后 1h单导联ST段抬高峰值简单且直观 ,不需计算 ,结合T波倒置时间 ,共同预测临床预后 ,有助于识别高危患者。

Objective This study was done to assess and compare the prognostic significance of multiple methods for measuring ST-segment elevation resolution following primary percutaneous coronary intervention(PCI) and the ability of a combined analysis of ST-segment resolution and time of T wave inversion to predict short-term outcome.Methods 268 patients with acute ST-segment elevation myocardial infarction undergoing primary percutaneous coronary angioplasty(PTCA) were observed.ST-segment resolution scores in single lead maximum and sum ST elevation were evaluated immediately and 1 h after angioplasty,and the absolute maximum ST elevation and sum ST elevation were measured in the two time points.The time of T wave inversion were examined.Result Multivariate regression analysis showed that the single maximum ST elevation 1 h after reperfusion therapy and time of T wave inversion as well as time-to-treatment were all independent predictors of in-hospital combined end point(recurrent ischemia,congestive heart failure,reinfarction,or severe rhythm disturbances and death).The sum ST elevation 1 h after reperfusion,time of T wave inversion,time-to-treatment were independent predictors.Conclusions The single lead maximum ST elevation 1 h after reperfusion therapy is very simple,inexpensive,and highly reliable measure which provides very strong early prognostic information.The combined analysis of single lead maximum ST elevation 1 h after reperfusion therapy and time of T wave inversion are useful method to predict outcome.