QT间期离散度对急性心肌梗死患者经皮冠状动脉介入治疗后主要心血管事件的预测价值

The Predictive Value of QT Dispersion for Major Adverse Cardiovascular Events in Patients With Acute Myocardial Infarction After Percutaneous Coronary Intervention Treatment

目的:本研究的目的是探讨伴有ST段抬高单一病变急性心肌梗死患者在经皮冠状动脉介入治疗(PCI)后QT间期离散度的变化,以及校正QT间期离散度(cQTd)变化与预后之间的关系。方法:符合入选标准的急性ST段抬高心肌梗死460例患者分为两组,主要心血管事件(MACE)组92例,非MACE组368例进入研究。一年随访发现,有92例(20%)发生MACE。本研究中采用12导联心电图的结果。MACE包括:死亡、非致死性心肌梗死、致死性心律失常和充血性心力衰竭。患者的临床基线资料包括:个人情况、住院信息、血脂水平、吸烟状况、超声心动图。统计分析主要采用多元Logistic回归和Kaplan-Meier分析。结果:cQTd绝对变化值非MACE组的中位数为31.7 ms,25和75分位数为12.1 ms和55.3 ms;MACE组的中位数为11.0 ms,25和75分位数分别为-5.2 ms和33.3 ms;非MACE组高于MACE组,差异有统计学意义(P<0.001)。cQTd相对变化值,非MACE组的中位数为40.1 ms,25和75分位数分别为13.6 ms和62.3 ms;MACE组的中位数为19.3 ms,25和75分位数分别为-15.8 ms和52.3 ms;非MACE组高于MACE组,差异有统计学意义(P<0.001)。多元Logistic回归分析发现,cQTd绝对变化值为MACE发生的独立危险因素,OR为0.74(95%CI:0.68～0.85)。Kaplan-Meier分析显示,cQTd变化值越大MACE发生率越低。结论:伴有ST段抬高单一病变急性心肌梗死患者中,cQTd绝对变化值对PCI后MACE的发生具有预测价值。

Objective ： To study ECG QT dispersion for major adverse cardiovascular events （MACE） in patients with acute ST elevated myocardial infarction（STEMI） after percutaneous coronary intervention（PCI）. Methods：A total of 460 STEMI patients treated in our hospital from 2008 to 2011 were recruited and followed-up for 1 year. The patients were divided into two groups as MACE group, n = 92 （20%）and Non-MACE group, n = 368. 12-lead ECG was used to study QT dispersion changes. MACE including death, non-fatal MI, life-threatening arrhythmias and heart failure. The patient＇ s basic condition including personal and treatment information, blood lipids, smoking status and echocardiography. Muhiple logistic regression and Kaplan-Meier analysis were conducted and compared between two groups. Results ：The absolute corrected QT dispersion changes in Non-MACE group and MACE group were 31.7 （ 12. 1 and 55.3 ） ms vs. 11.0（-5.2 and 33.3）ms,P〈0. 001. The relative corrected QT dispersion changes in Non-MACE group and MACE group were 40. 1 （ 13.6 and 62. 3 ） % vs. 19. 3 （ - 15.8 and 52.3 ） %, P〈0. 001. Multivariate analysis presented that the absolute corrected QT dispersion change was an independent predictor for MACE occurrence, OR 0. 74 （95% CI 0. 68 -0. 85）. Kaplan-Meier analysis showed that higher corrected QT dispersion changes predicted lower MACE occurrence. Conclusion ：The absolute corrected QT dispersion changes had predictive value for MACE occurrence in STEMI patients after PCI treatment.