急性心肌梗死患者直接PCI后心电图ST段回落与近期预后的关系研究

Relation between ST-segment resolution and proximal prognosis after primary PCI in patients with acute myocardial infarction

目的分析ST段抬高型急性心肌梗死(STEMI)直接经皮冠状动脉介入治疗(PCI)后心电图ST段早期回落和近期预后的相关性。方法 STEMI患者140例,按PCI后2 h心电图相关导联ST段抬高总和较术前的下降百分比(ΣSTR)分为A组(ΣSTR≥50%,84例)和B组(ΣSTR<50%,56例),比较两组患者PCI后梗死相关动脉(IRA)的TIMI血流分级、术后1周左心室射血分数(LVEF)及住院期间严重心脏不良事件(MACE)发生情况,对可能影响住院期间MACE的因素进行Logistic多因素回归分析。结果 A组术后1周LVEF(54.1±5.1)%明显高于B组(46.7±4.0)%;住院期间MACE发生率A组(6.0%)显著低于B组(25.0%),差异均有显著性意义,P<0.05。影响MACE的Logistic多因素回归分析进入回归方程的有ΣSTR、发病至IRA再通时间、糖尿病史,ΣSTR贡献最大。结论急性STEMI患者直接PCI后心电图相关导联ST段的早期回落对PCI后的近期预后有重要的独立预测作用。

Objective To investigate the relationship between early ST- segment resolution magnitude and short term prognosis after successful primary PCI in ST- elevated AMI（ STEMI） patients. Methods 140 consecutive STEMI patients who underwent primary PCI were enrolled in this study. ST- segment resolution was calculated and the patients were divided into group A（ n = 84,ΣSTE resolved≥50%） and group B（ n = 56,ΣSTE resolved 50%）. TIMI flow after PCI,clinical events 1 ~ 3 weeks after PCI and cardiac function about 7 days after PCI were assessed. Multifactor regression analysis was used to identify the factors that may affect major adverse cardiovascular events（ MACE） in the in- hospital period. Results LVEF was higher in group A than that of group B,（ 54. 1 ± 5. 1） % vs.（ 46. 7 ± 4. 0） %,P〈0. 05. The incidence of in-hospital MACE was also significantly less in group A than that in group B（ 6. 0% vs. 25. 0%,P〈0. 05）. Multivariate regression analysis showed that ΣSTR、symptom- onset- to- coronary revisualization time and diabetes were independent predictors in hospital adverse outcomes. Conclusion Early ST- segment resolution after primary PCI is the strongest independent predictor in in- hospital adverse outcomes for STEMI patients.