STEMI冠状动脉介入后Tp-ec及QTc与恶性心律失常的相关性

Correlation between Tp-ec and QTc with Malignant Arrhythmia after STEMI Coronary Artery Intervention

目的探讨经皮冠状动脉(冠脉)介入术(PCI)后ST段回落幅度(STR)、Tp-ec间期和Tp-e/QT比值变化与急性ST段抬高型心肌梗死(ST segment elevation myocardial infarction,STEMI)后恶性心律失常事件(malignant arrhythmia events,MAE)的关系。方法选择我院经冠脉造影确诊并在12 h内行PCI治疗的92例STEMI作为观察组,选择同期无器质性心脏病且心电图正常的健康体检者88例作为对照组。随访1个月统计观察组发生MAE情况,并比较术前、术后QTC间期、Tp-ec间期及Tp-e/QT测定值;将STR、QTc间期、Tp-ec间期、Tp-e/QT不同节点值发生MAE的例数及MAE发生的危险因素变量代入Cox进行多因素回归校正分析。结果本观察组共发生MAE 64例。观察组术前梗死及非梗死相关导联QTc间期、Tp-ec间期、Tp-e/QT比较及与对照组比较差异均有统计学意义(P<0.05);术后1周、1个月时Tp-ec间期和Tp-e/QT较前一时段相同导联减小(P<0.05),且非梗死相关导联均小于梗死相关导联(P<0.05),非梗死相关导联Tp-ec间期在术后1个月时恢复,其他均未恢复至正常水平(P<0.05),而QTc间期在术后1周各导联就已恢复至正常水平(P>0.05)。Cox多因素回归分析示:QTc间期≥440 ms、Tp-ec间期≥100 ms、Tp-e/QT≥0.25是STEMI患者PCI术后MAE发生的高风险因素。结论 STR、Tp-ec间期、Tp-e/QT是STEMI患者PCI术后发生MAE的独立预测因素,可指导临床诊断和治疗。

Objective To explore the value of the elevated ST segment resolution （STR）, Tp-ec （correction of T wave peak to the time） intermediate stage and Tp-e/ QT ratio changes after percutaneous coronary intervention （PCI） in prediction of malignant arrhythmia induced by acute ST segment elevation myocardial infarction （STEMI）. Methods A total of 92 patients with STEMI confirmed by coronary angiography and undergoing PCI therapy within 12 h were selected as observation group, and 88 healthy controls with normal ECG at the same period were chosen as control group. The incidence rate of MAE in observation group was observed within one month of follow-up, and the values of intermediate stages of QTC and Tp-ec and Tp-e/ QT before and after operation were compared; Cox multiple factor regression of correction analysis was performed with numbers of MAE pa-tients in different nodes of intermediate stages of STR, QTc, Tp-ec, and Tp-e/ QT, and risk factors affecting incidence rate of MAE. Results Sixty-four patients had MAE in observation group. The differences in values of QTc, Tp-ec and Tp-e/ QT radio before the operation between related lead with infarction and non-infarction in observation group, and compared with those in control group （P 〈0. 05）, the values of Tp-ec and Tp-e/ QT radio 1 week and 1 month after the operation were decreased, com-pared with the previous period of the same lead （P 〈0. 05）, and the values of non-infarction lead were lower than those of in-farction lead （P 〈0. 05）; non-infarction lead Tp-ec value returned to normal in postoperative 1 month （P 〈0. 05）, but other in-dexes did not return to normal, while the lead values of QTc in postoperative 1 week had returned to normal （P 〉 0. 05） Cox multiple factor regression analysis showed that the high risk factors of MAE for STEMI patients after PCI operation were QTc≥440 ms, Tp-ec ≥100 ms and Tp-e/ QT ≥0. 25. Conclusion STR, Tp-ec and Tp-e/ QT radio are independent predictors of MAE onset in STEMI patients after PCI therapy, which is valuable for the clinical diagnosis and treatment.