心电图对非ST段抬高型急性冠脉综合征危险分层的价值

The predicting value of electrocardiography deviation on risk stratification in patients with non-ST elevation acute coronary syndrome.

目的探讨心电图变化对非ST段抬高型急性冠状动脉综合征患者危险分层的价值。方法自2006年1月～2007年7月,在我院因急性胸痛拟诊不稳定型心绞痛及非ST段抬高心肌梗死而收入住院且记录资料完整的616例患者。入院后采集病史、查体,并在10min内完成常规18导联心电图检查,将患者入院时心电图的改变分为ST段压低组(包括伴有T波倒置者)、单纯T波倒置组、尚不能诊断的心电图组及正常心电图组;又将ST段压低组分为:胸前导联(V4～V6)ST段压低合并负向T波、胸前导联ST段压低合并正向T波、其他导联ST段压低合并正向T波、其他导联ST段压低合并负向T波4组。观察各组住院期主要心血管事件(心脏性死亡、非致命性心肌梗死、反复缺血性心绞痛发作),并随访1～12(7.2±3.8)个月,观察主要心血管事件变化。结果与正常心电图组比较,ST段压低组的复合心血管事件明显增多。胸前导联ST段压低合并T波倒置组的患者较其他导联ST段压低合并或不合并T波倒置组的复合心血管事件明显增多。结论心电图的ST段变化对非ST段抬高型急性冠状动脉综合征患者的危险分层及心血管事件预测均有重要价值。

Objective To investigate the predicting value of electrocardiography （ECG） deviation on risk stratification in patients with non-ST elevation Acute coronary syndromes （ACS）.Methods 616 patients with acute chest pain were admitted to hospital consecutivelywith the diagnosis of unstable angina pectorisor non-ST elevation myocardial infarction from Jan 2006 to July 2007.The case history was collected and thePhysieal examination and 18 leads of ECG test within 10 min after hospitalization were performed.All patients were assigned to ST depression group （including accompanied T wave inversion）,solely T wave inversion group, ST elevation group and normal ECG group respectively according to the ECG deviation at admission： ST depression group were aasigned to ST depression and/or inverted T wave in leads V4 to V6, ST depression and/or inverted T wave in all other leads.The major adverse cardiovascular events （MACE）,including cardiac death,non fatal myocardial infarction and recurrent ischemia angina,were analyzed in each group in-hospital and follow-upperiod. Results The incidences of recurrent angina and combined cardiovascular events increased significantly in ST depression group than in normal ECG group. The incidences of recurrent angina and combined Cardiovascular events increased significantly in ST depression with inverted T waves in leads V4 to V6 group than in all other groups.Conclusions The changes of ST segment play an important role on risk stratification and prediction of cardiovascular events in patients with non,ST elevation ACS.