持续ST段抬高对直接经皮冠脉介入治疗疗效的影响

The impact on persistent ST-segment elevation to the effect of direct percutaneous coronary intervention

目的探讨心电图梗死相关导联持续ST段抬高对判断直接PCI治疗AMI疗效的应用价值。方法根据心电图梗死相关导联ST段抬高回落情况将229例直接PCI后TIMI血流3级的AMI患者分2组:ST段回落>50%组(甲组),147例;与ST段回落<50%组(乙组),82例,比较两组一般临床特征,随访心血管事件的发生率。结果甲乙两组:无复流(blush分级<2级)为14/147(9.5%)和21/82(25.6%);住院期间病死率5/147(3.40%)和9/82(11.0%);MACE 8/147(5.4%)和11/82(13.4%);心功能EF数值56.99±9.78和49.82±8.78比较,P<0.05,均有明显统计学差异。随访期间病死率2/147(1.34%)和3/82(3.7%);MACE 10/147(5.4%)和7/82(8.5%),P>0.05,均无统计学差异。结论心电图梗死相关导联ST段抬高回落情况可作为直接PCI后心肌组织水平再灌注及预后判断的指标。

Objective To discuss the value of persistent ST-segment elevation on infarct related leads of electrocardiogram to judge the effect of direct percutaneous coronary intervention（PCI）in acute myocardial infarction （AMI）. Methods 229 AMI patients already been undertaken direct PCI with the flow of TIMI Ⅲ were divided into two groups. According to the results of ST-segment elevation resolution on infarct related leads in electrocardiogram： the group of ST-segment elevation resolution more than 50% （group A）and the group of ST-segment elevation resolution less than 50 % （group B）. The basic clinical features between the two groups, and the followed up frequency of cardiac events were compared. Results The comparisons between group A with group B showed ： no-reflow as 14/ 147（9.52% ）VS 21/82（25.61 % ） ;the mortality during in-hospital period 5/147（3.40% ）VS 9/82（ 10.98% ） ;MACE 8/147（5.44%）VS 11/82（13.4%）;the value of LVEF56.99%±9.78% VS 49.82% ±8.78%,P 〈0.05.All were statistically significant. During follow-up, the comparisons between these two groups demonstrated mortality 2/147 （1.36%） VS 3/82 （3.66%）; MACE 10/147 （5.44%） VS 7/82（8.54%）, P 〉 0.05, showing statistically insignificant. Conclusions That the results of ST-segment elevation resolution on infarct related leads in electrocardiogram can be used as an index for reperfusion of myocardial tissue level and judgment of prognosis after direct PCI.