急性心肌梗死经皮冠状动脉介入治疗后ST段回落不良的相关因素

Analysis of predictive factors associated with no ST-segment resolution in patients underwent percutaneous coronary intervention for acute myocardial infarction

目的探讨急性心肌梗死急诊直接经皮冠状动脉介入（PCI）术后ST段回落（STR）不良的相关因素。方法对556例ST段抬高型急性心肌梗死患者行急诊直接PCI术，术前及术后1h各记录心电图1次，分析STR情况。STR≥50％患者为STR组（387例），STR〈50％患者为STR不良组（169例），分析2组患者的临床资料，并加以比较。结果STR组与STR不良组患者性别、年龄和糖尿病、高血压患者比例及血TC、LDL、TG水平差异无统计学意义（均P〉0．05）。STR不良组入院时血白细胞计数、胸痛至再灌注时间及前壁心肌梗死、入院心功能killip分级〉2级患者比例高于STR组[分别为（12．1±3．1）×10^9／L比（10．1±2．3）×10^9／L，（8±5）h比（5±3）h，51．5％（87／169）比32．1％（124／387），43．8％（74／169）比24．5％（95／387）]，心肌梗死前心绞痛患者比例低于STR组[49．7％（84／169）比69．0％（267／387）]，差异均有统计学意义（均P〈0．05）。结论入院时血白细胞计数及心肌梗死前心绞痛、急性前壁心肌梗死、胸痛至再灌注时间、入院心功能killip分级〉2级是ST段抬高型急性心肌梗死患者PCI术后STR不良的相关因素。

Objective To explore the predictors of no ST-segment resolution （no-STR） in patients who have underwent percutaneous coronary intervention（PCI） for acute myocardial infarction （AMI）. Methods All 556 patients with ST-elevated AMI were divided into STR group（ STR I〉50%, 387 eases） and no STR group（ STR 〈 50%, 169 eases）. The situation of STR was detected before and after PCI, and the clinical data of patients were compared and analyzed. Results The clinical data had no significant difference （ P 〉 0.05 ） , while the white blood cell count, the time from chest pain to reperfusion, the occurrence of acute anterior myocardial infarction and cardiac functions（ killip 〉 2 ） in no STR group were higher than those in STR group [ （ 12. 1 ± 3.1 ）×10^9/L vs （ 10.1 ± 2.3）×10^9/L, （8±5）hvs（5 ±3）h, 51.5% （87/169） vs 32.1% （124/387）, 43.8% （74/169） vs 24.5% （95/387） ] , and the occurrence of angina before myocardial infarction in no STR group was less than that in STR group [ 49.7% （ 84/169 ） vs 69. 0% （ 267/387 ） ], and there were significant differences （ all P 〈 0. 05 ）. Conclusion The no STR of patients with ST elevated AMI may be associated with hospitalized white blood cell count, occurrence of angina befor myocardial infarction, acute anterior myocardial infarction, the time from chest pain to reperfusion and hospitalized cardiac function（ killip 〉 2）.