急性前壁ST段抬高心肌梗死急诊经皮冠状动脉介入治疗后单导联ST段回落程度对预后的影响

Single lead ST-segment resolution in acute anterior ST-elevation myocardial infarction after primary percutaneous coronary intervention：prognostic impact

目的探讨急性前壁sT段抬高心肌梗死（sTEMI）急诊经皮冠状动脉介入治疗（PCI）后单导联sT段回落程度对临床预后的影响，以早期识别高危患者，从而积极提高心肌组织的再灌注。方法回顾性分析42例急性前壁STEMI患者的临床资料，其中sT段回落良好组31例，sT段回落不良组11例，比较两组患者冠状动脉造影结果、治疗前后用药及住院期间主要不良心脏事件（MACE）发生的差异。结果sT段回落不良组糖尿病比例高于sT段回落良好组（10／11比7／31），左室射血分数低于sT段回落良好组[（48．2±10．1）％比（54．6±9．7）％]，差异均有统计学意义（尸〈0．05）。ST段回落不良组冠状动脉内明显血栓、术前TIMI血流0～1级、术后TIMI血流≤2级、MACE比例均高于sT段回落良好组，起病至球囊开通时间长于sT段回落良好组，差异均有统计学意义（P〈0．05）。结论急性前壁STEMI患者PCI术后单导联ST段回落程度可以预测MACE发生率，能识别PCI后的高危患者。

Objective To evaluate the prognostic value of ST-segment resolution （STR） measured in a single electrocardiography lead obtained early after primary percutaneous coronary intervention （PCI）in patients with acute anterior ST-elevatian myocardial infarction （STEMI）. Methods STR, major adverse cardiac event（ MACE ） and factors contributed to STR were analyzed retrospectively in 42 patients underwent primary PCI post STEMI. The coronary arteriography, medication and MACE were compared between the STR group （31 cases） and the non-STR group （ 11 cases）. Results The ratio of diabetes in the non-STR group was higher（ 10/11 ） than that in the STR group（7/31 ）, but left ventricular ejection fraction [（48.2 ± 10.1 ）% ] was lower than that in the STR group [ （54.6 ± 9.7）% 1, there were significant difference between the two groups （P 〈 0.05）. The coronary artery thrombosis, TIMI grade 0-1 preoperation, TIMI grade ≤2 postoperation, the ratio of MACE in the non-STR group was higher than those in the STR group, onste to sacculus proprius opened was longer than that in the STR group, there were significant difference between the two groups （P 〈 0.05）. Conclusions STR obtained in a single electrocardiography lead is an easy and important prognosticator of MACE post PCI in patients with STEMI. It can be used to identify high-risk anterior STEMI patients post primary PCI, and support some ways use in high-risk STEMI undergoing reperfusion.