ST段抬高型急性心肌梗死患者急诊冠状动脉介入治疗后ST段24 h内演变的临床价值

Clinical values of ST-segment changes in ST-segment elevated myocardial infarction patients within 24 hours post primary percutaneous coronary interventions

目的 探讨ST段抬高型急性心肌梗死（STEMI）急诊经皮冠状动脉介入（PCI）术后24h内心电图ST段演变的临床意义.方法 2012年6月至2013年12月就诊中国医科大学第一附属医院的225例STEMI患者,按照PCI术后1h心电图ST段抬高振幅总和（∑STE）较术前下降是否≥50％分为A组（≥50％,135例）及B组（＜50％,90例）,分析PCI后冠状动脉TIMI血流、ST段回落和住院期间术后1周左心室射血分数（LVEF）、住院期间主要心血管不良事件（MACE）的关系.继续观察B组心电图至术后24h,按术后24 h∑STE较术前下降是否≥50％分为C组（≥50％,56例）及D组（＜50％,34例）,同样分析这两组患者心电图ST段延迟回落和预后的相关性.结果 A、B两组间年龄、性别等一般资料比较差异均无统计学意义,仅术前Killip≥Ⅱ级B组高于A组[37.8％（34/90）比17.0％（23/135）,P＜0.05];C、D两组间年龄、性别等一般资料比较差异均无统计学意义,而合并糖尿病比例D组高于C组（P＜0.05）,D组术前Killip≥Ⅱ级[55.9％（19/34）比26.8％（15/56）,P＜0.05]和多支血管病变比例[70.6％（24/34）比35.7％ （20/56）,P＜0.05]均高于C组,A、B两组差异无统计学意义.TIMI 3级血流比例、发病至冠状动脉开通时间A、B两组及C、D两组比较差异均无统计学意义.住院期间总MACE发生率B组高于A组[14.4％ （13/90）比3.0％（4/135）,P＜0.05],C、D两组术后1周LVEF、住院期间MACE发生率及各个事件分别比较差异均无统计学意义.结论 STEMI患者急诊PCI术后心电图ST段的早期回落可能反映心肌灌注水平,协助评价早期预后,而术后24 h ST段的延迟回落无同样价值.

Objective To explore the clinical values of ST-segment changes in ST-segment elevated myocardial infarction （STEMI） patients within 24 hours after primary percutaneous coronary intervention （PCI）.Methods A total of 225 patients with STEMI underwent primary PCI were enrolled,the ST segment resolution 1 hour after PCI was calculated and the patients were divided into group A （n =135,∑STE resolved ≥ 50%） and group B （n =90,∑STE resolved 〈 50%）.The patients in group B were further divided into group C （n =56,∑STE resolved ≥ 50%） and group D （n =34,∑STE resolved 〈 50%） according to the ST segment resolution at 24 hours after PCI.TIMI flow after PCI,in-hospital major adverse cardiac events（MACE） and cardiac function about 7 days post PCI were analyzed.Results Data between group A and group B were similar except the incidence of pre-PCI Killip ≥ Ⅱ was significantly higher in group B than in group A （37.8% （34/90） vs.17.0% （23/135）,P 〈 0.05）.Incidence of complicated diabetes （P 〈0.05）,pre-PCI Killip≥ Ⅱ （55.9% （19/34） vs.26.8% （15/56）,P 〈0.05） and multivessel disease（70.6% （24/34） vs.35.7% （20/56）,P 〈 0.05） were significantly higher in group D than in group C.TIMI 3 and the opening time of IRA was similar between group A and group B and between group C and group D.The incidence of in-hospital MACE was significantly higher in group B than in group A （14.4% （13/90） vs.3.0% （4/135）,P 〈 0.05） which was similar between group C and group D.Conclusion Early （1 hour） but not late （24 hours） ST resolution post PCI is related to a favorable clinical outcome in STEMI patients.