冠状动脉内心电图ST段改变在经皮冠状动脉介入术中心肌损伤早期识别中的价值探讨

Intracoronary ST-segment shift in diagnosis of early myocardial injury during percutaneous coronary intervention

目的 探讨冠状动脉（冠脉）内心电图在经皮冠脉介入治疗术（PCI）中早期识别心肌损伤的价值.方法 入选86例术前肌酸激酶同工酶（CK-MB）及肌钙蛋白T（cTnT）值正常、接受择期PCI治疗单支血管的冠心病患者,通过冠脉内导丝记录患者PCI术中冠脉远端心电图,依据其是否发现有意义的心电图ST段改变分为变化组和对照组.测定患者术后8 h、24 h的cTnT、CK-MB.比较两组患者问cTnT、CK-MB水平及患者术中、术后4周内心脏事件发生情况.结果 86例患者PCI治疗术中30例（35%）出现有意义的冠脉内心电图改变（变化组）,其余56例（65%）未见有意义的冠脉内心电图变化及体表心电图改变（对照组）.变化组患者术后cTnT和CK-MB明显较对照组患者升高,差异有统计学意义（P〈0.01）.有意义的冠脉内心电图改变对预测心肌损伤的敏感性为77%,特异性为94%,其阳性预测值和阴性预测值分别为90%、86%.术后4周内变化组患者心脏事件发生率较对照组患者高（P〈0.05）.结论 冠脉内心电图ST段的改变有助于即刻识别PCI术中心肌损伤.

Objective To evaluate role of intracoronary electrocardiogram （IcECG） in examining early myocardial damage during elective percutaneous coronary intervention （PCI）. Methods Eighty-six patients of coronary heart disease with normal serum levels of creatine kinase-myoglobin （CK-MB） and cardiac troponin T （cTnT） before the procedure and undergone elective PCI were enrolled in the study.Their IcECG were recorded by a intracoronary guidewire and serum levels of CK-MB and cTnT were measured at baseline and eight and 24 hours after the procedure, respectively. The patients were divided into two group, abnormal and control, according to whether they had significant shift at ST-segment in IcECG.Cardiac events after intervention in the patients were followed-up and recorded. Myocardial damage was defined as serum level of cTnT increased to above the upper normal value after intervention. Results Significant shift at ST-segment in IcECG during PCI in 30 （35%, abnormal group） and no shift in other 56patients （65%, control group） of 86 patients with normal serum levels of cardiac markers before the procedure was observed, and all the procedure were successful Serum levels of cTuT and CK-MB significantly increased after intervention in 30 patients of abnormal group than those in control one （ P 〈0. 01 ）. Sensitivity of intracoronary ST-segment shift was 77 percent for predicting myocardial damage, and specificity was 94 percent, with positive and negative predictive values of 90 percent and 86 percent,respectively. More cardiac events were observed at 4-week follow-up after intervention in abnormal group than those in control one （P〈0. 05） and major coronary event-free survival was significantly lower in those with post-procedural ST-segment elevation in IeECG （P 〈 0. 05）. Conclusions ST-segment shift in IcECG may be helpful for predicting myocardial damage during PCI procedure on time.