STEMI患者PCI术后单导联ST段回落不良的临床观察

目的探讨sT段抬高型急性心肌梗死（STEMI）患者经皮冠状动脉介入（PCI）治疗后sT段回落（STR）不良的相关因素、对预后的影响，以及替罗非班对其预后的影响。方法收集116例行急诊PCI术的STEMI患者的临床资料，及心电图、冠脉造影、心超结果，记录院内不良心血管事件（MACE），按术后sT段下降≥50％与〈50％，将患者分为STR良好组与STR不良组，统计分析其相关因素及短期预后，比较替罗非班应用对STR不良患者的MACE发生率的影响，筛选院内心血管不良事件发生的独立预测因素。结果STR不良与心功能分级、合并糖尿病、存在左主干病变、起病至球囊扩张时间呈显著正相关；STR不良组MACE发生率显著高于STR组，左室射血分数则显著低于STR组；应用替罗非班可显著降低MACE发生率；且STR不良是MACE的独立预测因素之一。结论心肌梗死患者sT段回落不良反应了心肌组织水平灌注不良，这些患者发生MACE的风险明显升高，而替罗非班能有效干预。

Objective To analyze the associated factors and short - term prognostic value of ST - segment resolution （STR） in a single ECG lead obtained early primary percutaneous coronary intervention in patients with ST - elevation myocardial infarction （STEMI） , and to observe the effect of tirofiban on patients＇ prognostic. Methods Retrospective study was carried out on clinical data, electrocardiogram, coronary angiography, eehocardiogram and major adverse cardiac events （MACE） in 116 patients undergoing primary PCI post STEMI. According to the degree of STR after PCI, the patients were divided into STR（ ≥50% ） group and non -STR（ 〈 50% ） group. All the date above were compared between the STR and non -STR groups for statistical analysis. Comparison of the incidence of MACE between application of tirofiban or not in non - STR group was also done. Results The incidence of diabetes mellitus, left main coronary artery process, cardiac dysfunction Killip - grade were significantly higher in non - STR group, and time of onset - to - ballon was longer. The non - STR group had higher MACE rate and lower LVEF than STR group. Tirofiban used after PCI treatment for non - STR can effectively reduce the incidence of MACE, and non - STR was one of the independent predictors of in - hospital MACE. Conclusions STR obtained in a single ECG lead is an important prognosticator of MACE, it could evaluate the level of myocardial tissue perfusion, tirofiban can effectively reduce the risk.