急诊经皮冠状动脉介入治疗后心电图ST段回落程度与预后的观察

Prognostic value of ST-segment resolution after percutaneous coronary intervention in the patients with acute ST-segment elevation myocardial infarction

目的:探讨急性ST段抬高型心肌梗死(STEMI)直接经皮冠状动脉介入治疗(PCI)后心电图ST段的回落程度与预后的关系。方法:入选225例患者,其中急性前壁梗死118例,非前壁心肌梗死107例。依据PCI后心电图ST段抬高总和与总回落百分比(sumSTR)将全部患者分为sumSTR>70%组(完全回落组)、30%<sum-STR≤70%组(部分回落组)及sumSTR≤30%组(未回落组),并对这3组患者的住院期间左室射血分数及6个月内总的主要心血管事件(MACE,包括心绞痛、再发心肌梗死、因心血管事件再入院、心力衰竭和死亡等)发生率的相关性进行对比分析。另外,对可能影响随访期间MACE发生的因素进行多因素回归分析。结果:完全回落组住院期间的左室射血分数[(56.62±7.53)%]较部分回落组[(53.4±9.45)%]及未回落组[(54.3±8.66)%]显著升高,均P<0.05;完全回落组6个月内MACE发生率(16.3%)显著低于部分回落组(39.3%)和未回落组(48.3%),均P<0.01。Logistic多因素回归分析提示前壁心肌梗死、sumSTR是随访6个月内MACE发生率的独立预测因子。结论:sumSTR与患者住院期间左室射血分数、6个月内MACE发生率相关;前壁心肌梗死、sumSTR是随访6个月内MACE发生率的独立预测因子。

Objective：This article was undertaken to investigate the relationship between the prognosis and the amount of ST segments resolution in patients with acute ST-segment elevation myocardial infarction（STEMI） treated by percutaneous coronary intervention（PCI）. Method：Total of 225 cases of patients were divided into three groups according to sum of the relative ST-segments resolution（sumSTR）： sumSTR70%（complete resolution group）,30%sumSTR≤70%（partial resolution group） and sumSTR≤30%（no resolution group）.The values of left ventricular ejection fraction（LVEF） by UCG during hospitalization and the incidence of major adverse cardiac events（MACE） at 6 months post PCI were compared and analysed.In addition,multi-factor regression analysis was used to identify the factors that may affect major adverse cardiovascular events in the follow-up period. Result：Two hundred and twenty five patients aged 61.3±12.7 were enrolled in this retrospective study,in which 156 were male,one hundred and eighteen patients had acute anterior infarction,and one hundred and seven had non-acute anterior infarction.Seventy patients had major adverse cardiovascular events in the follow-up period.Patients with sumSTR70% had higher values of LVEF compared to patients with 30%sumSTR≤70%（56.62±7.53 vs 53.4±9.45,P=0.022） and patents with sumSTR≤30%（56.62±7.53 vs 54.3±8.66,P=0.049,P=0.022）.The incidence of MACE at 6 months post PCI was lower in the patients with sumSTR70% compared to patients with 30%sumSTR≤70%（16.3% vs 39.3%,P=0.001） and patients with sumSTR≤30%（16.3% vs 48.3%,P=0.001）.Multivariate regression analysis showed that anterior infarction and poor sumSTR were independent predictors of major adverse cardiovascular events in 6 months follow up. Conclusion：This study show that amounts of sumSTR post primary PCI was closely correlated with the values of LVEF and incidence of MACE in the patients with STEMI.Anterior infarction and poor sumSTR were independent predictors of 6 months major adverse cardiovascular events in the same patients.