急性ST段抬高心肌梗死介入治疗后单导联ST段抬高峰值对近期及远期心脏不良事件的预测价值

The appreciation of short term and long term cardiac vent value of maximum ST-segment elevation (maxSTE) after interventional therapy in the patients with acute ST-segment elevation myocardial infarction (STEMI)

目的评价急性ST段抬高心肌梗死(STEMI)介入治疗后单导联ST段抬高峰值(maxSTE)对近期及远期心脏不良事件的预测价值。方法268例STEMI患者于再灌注治疗前后动态观察心电图,采用反映ST段恢复的不同计算方法,包括术前、术后即刻、术后1 h ST段抬高总和(sumSTE)、单导联ST段抬高峰值(maxSTE)、ST段抬高总和的恢复百分比(sumSTR)、单导联ST段抬高峰值恢复百分比(maxSTR),评价其对6个月内及远期心脏不良事件的预测价值。结果多元回归分析显示,年龄和术后1 h sumSTE是预测6个月内心脏不良事件独立的因子;仅maxSTE危险分层是6个月死亡独立的预测因子;maxSTE危险分层与术后1 h sumSTE均对2 a以上的远期心脏不良事件具有独立预测价值;maxSTE高危组较中低危组6个月心脏不良事件增加2.3倍(P=0.000),死亡增加6倍(P=0.000),远期心脏不良事件增加4.5倍(P=0.000)。结论maxSTE高危是STEMI再灌注治疗后6个月死亡最强的预测因子,对远期心脏不良事件仍有独立的预测价值。maxSTE危险分层较其他ST段测量方法更加简单直观,有助于识别高危病人。

Objective To investigate the prognostic value of short term and long term cardiac events with different measurements, such as maxSTE, after interventional therapy in the patients of STEMI. Methods ECG was taken for 268 cases of STEMI before and after interventional therapy, sumSTE, maxSTE, the resolution of sumSTE （sumSTR%）, the resolution of maxSTE （maxSTR%） and the categorical variable based upon maxSTE were calculated, and the prognostic value of them was analyzed after more than two years followup. Results By muhivariate analysis, age and sumSTE（1h） were independently predictors of 6 months cardiac events, bnt only the maxSTE high - risk categorization independently predicted the 6 months mortality; in up to two years, maxSTE high risk categorization was also an independent predictor of long - term cardiac events as strong as sumSTE. In maxSTE high - risk group, the mortality was 6 times higher than the lower- risk group, and the frequence of cardiac events was 2.3 times higher in 6 months and 4.5 times higher in up to 2 years than the lower - risk group. （ P = 0.000）.Conclusion MaxSTE high- risk categorization correlated strongly with the 6 - month mortality and long- term cardiac events as strong as sumSTE , but the measurement of maxSTE was simpler than sumSTE, Which helped to screen patients with high risk.