急性心肌梗死经皮腔内冠脉介入治疗后心电图ST段回落不良对临床预后的影响

The impact of poor ST-segment resolution after PCI on clinical outcomes in patients with acute myocardial infarction

目的探讨ST段抬高型急性前壁心肌梗死急诊直接经皮腔内冠状动脉介入治疗(PCI)后,心电图ST段回落(STR)对临床预后的影响。方法对65例ST段抬高型急性前壁心肌梗死患者进行急诊直接PCI术前、术后1h各记录心电图1次,检测STR情况。PCI术后1hSTR≥50%患者为STR组(46例),STR<50%者为STR不良组(19例),术后1、6、12个月各进行三维彩色超声心动图检查1次,测量患者左室射血分数(LVEF)、左室舒张末径(LVEDd)。随访1年,观察患者PCI术后1年内心血管事件发生率。结果 STR不良组1、6、12个月的LVEF值低于STR组(P均<0.05),LVEDd值大于STR组(P均<0.05),心血管事件发生率稍高于STR组,但差异无统计学意义(P>0.05)。结论 ST段抬高型急性前壁心肌梗死直接PCI后1hSTR不良者预后差、心血管事件发生率较高、左室心功能恢复不良。

Objective To explore the impact of ST-segment resolution （STR）in electrocardiogram （ECG） after emergent primary percutaneous transluminal coronary intervention（PCI）on clinical prognosis in patients with ST-elevated acute anterior myocardial infarction.Methods Sixty-five patients with ST-elevated acute anterior myocardial infarction underwent emergent primary PCI were enrolled in present study. ECG was recorded at one hour before and after PCI respectively in all patients to observe STR. The patients were grouped according to STR at one hour after PCI： STR ≥50% group （STR group, n=46） and STR 50% group （ poor STR group, n=19）. The left ventricular ejection fraction （LVEF） and left ventricular end-diastolic dimension （LVEDd） were detected by three-dimensional color echocardiography at 1-, 6-and 12-month after PCI respectively. The incidence of cardiovascular events was observed within 1 year after PCI.Results During the follow up of 1-,6-and 12 month after PCI, LVEF values in poor STR group were all lower than those in STR group （all P0.05）,and LVEDd values in poor STR group were all larger than those in STR group （all P0.05）. The incidence of cardiovascular events within 1 year after PCI in poor STR group was slightly higher than that in STR group, but without statistical significance （P0.05）. Conclusion The poor STR at 1 hour after primary PCI might be involved in the poor prognosis, the high incidence of cardiovascular events and poor ability to recover the left ventricular function in patients with ST-elevated acute anterior myocardial infarction.