急诊PCI术对心肌梗死患者QTc、Tp-Te、Tp-Tec间期的影响

Effects of primary percutaneous coronary intervention in patients with acute ST-elevation myocardial infarction at QTc, Tp-Te and Tp-Tec interval

目的:观察急性ST段抬高型心肌梗死(STEMI)患者急诊经皮冠状动脉介入治疗(p PCI)前后心室肌跨壁复极离散度指标(QTc、Tp-Te、Tp-Tec间期)的差异。方法:回顾分析245例STEMI患者,其中行p PCI治疗(干预组)188例,未行p PCI(对照组)57例,采集其入院即刻及入院第3天标准12导联心电图进行分析。结果:(1)干预组患者入院第3天和入院即刻比较,QTc间期无明显变化(P=0.277),Tp-Te间期、Tp-Tec间期均明显减小(P<0.001);对照组患者入院第3天和入院即刻比较,QTc间期较前增大,Tp-Te间期、Tp-Tec间期均较前减小(P分别为:0.018,0.003,0.001);与对照组比较,干预组入院第3天Tp-Te、Tp-Tec间期减小更明显。(2)干预组与对照组相比,住院期间恶性心律失常事件发生率降低(P<0.05)。结论:急诊PCI术可使Tp-Te间期、Tp-Tec间期明显减小,比药物治疗可更有效地改善心室肌跨壁复极离散度,使恶性心律失常发生率降低。

Objective： To observe the effects of primary percutaneous coronary intervention （pPCI） in patients with acute ST-elevation myocardial infarction（STEMI） on transmural dispersion of repolarization （TDR）. Methods： A retrospective analysis on 245 cases with acute STEMI. All of the patients were divided into two groups： 188 cases undergoing pPCI treatment as the intervention group, and 57 cases without pPCI treatment as the control group. Corrected QT interval （QTc） and T-wave peak to end interval before and after correcting heart rate （Tp-Te, Tp-Tee） were measured on admission and on the third day after admission. Results： （ 1 ）Intervention group： QTe interval on the third day had no statistical significance compared with that on admission （P=0.277）, while the Tp-Te, Tp-Tec intervals were both significantly decreased （P〈0.001）. Control group： QTc interval was longer on the third day and Tp-Te, Tp-Tec intervals were both significantly decreased （P〈0.05）, as compared to the intervention group;（2 ）Comparing with the control group, the intervention group had a lower incidence of malignant arrhythmia （P〈0.05）. Conclusion： Primary PCI could make Tp-Te, Tp-Tec intervals decrease significantly, thus improving TDR and reducing the incidence of malignant arrhythmia as compared to absolute medicine therapy.