STEMI 冠脉病变程度与恶性心律失常的关系

The relationship between coronary artery lesions and malignant arrhythmia in STEMI patients

目的：观察急性ST段抬高型心肌梗死（ STEMI）行直接经皮冠状动脉介入治疗（ PCI）患者冠脉病变程度与恶性心律失常的关系，指导临床防治。方法采用回顾性分析的方法连续收集2008年1月至2010年12月中国医科大学附属第一医院心内科诊断为STEMI并行直接PCI的住院患者418例。入院后均给予心电监护观察，根据是否发生恶性心律失常[定义为持续性室速（ sVT）或室颤（ VF）]分为无sVT/VF和sVT/VF两组。在发生sVT/VF的患者中，按sVT/VF发生时间分为2组：术前sVT/VF组，术后sVT/VF组。计算STEMI患者的冠脉病变程度，统计Gensini评分＜60分、Gensini评分≥60分且＜120分、Gensini评分≥120分患者的sVT/VF发生情况。观察STEMI行直接PCI患者冠脉病变程度与恶性心律失常的关系。结果共有47例（11.2％）患者发生sVT/VF，直接PCI术前发生sVT/VF 22例（44.8％），术后发生25例（53.3％）。 sVT/VF组Killip分级＞I级、心率快、血压低、射血分数低（ P ＜0.05），Gensini评分分组间总sVT/VF及术前sVT/VF的发生率差异有统计学意义（7.1％vs 10.8％vs 20.5％， P ＝0.012；2.1％vs 5.9％vs 9.6％， P ＝0.045）；直接PCI Gensini评分分组间术后sVT/VF的发生率差异无统计学意义（5.0％vs 4.9％vs 11.0％， P ＝0.142）；用年龄（ x±2）、性别、高血压、糖尿病1∶2配对Logistic回归分析显示心率≥80次/min（ P ＝0.04， OR：2.667，95％CI：1.043-6.815）是术前发生sVT/VF的独立危险因素， Gensini评分不是术前发生恶性心律失常的独立危险因素。结论 STEMI行直接PCI患者中，冠脉程度越重术前恶性心律失常的发生率可能越高，但是术后的恶性心律失常发生率无明显差异。

Objective To investigate the relationship between the severity of coronary artery disease and malignant arrhythmia in the acute ST segment elevation myocardial infarction （STEMI） undergoing primary percutaneous coronary intervention （PCI）, and guide clinical prevention and treatment .Methods By retrospective analysis method , 418 cases of hospitalized patients with a diagno-sis of STEMI undergoing direct PCI were continuously collected in the Department of Cardiology , the First Affiliated Hospital of China Medical University, from 2008 January to 2010 December.Electrocardiography （ECG） was given after admission.Those patients were divided into two groups according to whether the occurrence of malignant ventricular arrhythmias that was defined as sustained ventricu -lar tachycardia （sVT） or ventricular fibrillation （VF）].In sVT/VF patients, the preoperative and postoperative groups were divided according to sVT/VF time.The degree of coronary artery lesions was calculated in patients with STEMI .The incidence of sVT/VF was counted in each group with Gensini scores 〈60,≥60 and〈120, and ≥120.The relationship between the severity of coronary le-sions and malignant arrhythmia was observed in STEMI undergoing direct PCI patients .Results ⑴In this study , a total of 47 cases （ 11.2%） occurred with sVT/VF in patients;Killip grade 〉I, fast heart rate , low blood pressure , and low ejection fraction were risk factors of sVT/VF（ P 〈0.05）.The occurrence of sVT/VF among the Gensini groups were significant difference （7.1%vs 10.8%vs 20.5%, P =0.012 ） .⑵The occurrence of sVT/VF was 44.8% （ 22 patients ） with direct PCI before operation; the preoperative sVT/VF rate among the Gensini groups had significant difference （2.1%vs 5.9%vs 9.6%, P =0.045）.⑶The occurrence of sVT/VF is 53.3%（25 patients） with direct PCI after operation; the postoperative sVT/VF rate among Gensini groups had no significant difference（5.0%vs 4.9%vs 11.0%, P =0.142）;⑷Paired with age （ x±2）, gender, hypertension, and diabetes 1, Logistic re-gression analysis showed that the heart rate greater than 80 beats /min （ P =0.04 , OR：2.667 , 95%CI：1.043-6.815 ） was an independent risk factor of preoperative sVT/VF, that Gensini score was not an independent risk factor of preoperative malignant ar -rhythmia.Conclusions For STEMI PCI patients, the more serious the degree of coronary artery is , the higher may be preoperative＆amp;nbsp;malignant arrhythmia , while the postoperative malignant arrhythmia rate has no significant difference .