急性冠状动脉综合征患者罪犯血管开通前后心电图QRS-T夹角改变及其临床意义

The changes of QRS-T corner after percutaneous coronary intervention in patients with acute coronary syndrome

目的探讨急性冠脉综合征(ACS)患者罪犯血管开通前后QRS-T夹角改变及其临床意义。方法连续性收集2013年1月—2014年6月南阳市第二人民医院160例ACS患者(ACS组)和40例非冠心病患者(对照组),160例ACS患者(ACS组)中不稳定型心绞痛(UAP亚组)72例,非ST段拾高性心肌梗死(NSTEMI亚组)患者48例,ST段抬高性心肌梗死(STEMI亚组)患者加例。根据Gensini积分情况评价冠状动脉病变程度,分为轻度亚组(Gensini积分≤20分)36例,中度亚组(20分<Gensini积分≤40分)90例,重度亚组(Gensini积分>40分)34例。综合分析ACS患者术前和术后额面QRS-T夹角改变情况与主要不良心脏事件(MACE)的相关性。结果 ACS组患者PCI术前额面QRS-T夹角均明显高于对照组(F=5.182,P=0.023)。STEMI亚组患者额面QRS-T夹角明显高于UAP亚组患者(t=1.819,P=0.039);STEMI亚组患者经过PCI治疗后额面QRS-T夹角明显下降(t=1.761,P=0.041)。STEMI亚组、NSTEMI亚组患者术前平均Gensini积分均高于UAP亚组(t=1.822、1.939,P<0.05)。术后随访,STEMI亚组、NSTEMI亚组患者MACE事件发生率低于UAP亚组(x^2=1.905、2.541,P<0.05)。中度亚组和重度亚组患者术前额面QRS-T夹角水平明显高于轻度亚组患者(P<0.05)。与术前比较,术后仅重度亚组患者PCI术后额面QRS-T夹角出现明显下降(t=1.801,P=0.040)。重度亚组患者MACE发生率明显高于轻度亚组、中度亚组(P<0.05)。术前及△(术前-术后)额面QRS-T夹角水平对MACE发生具有一定的诊断预测价值(AUC=0.632,95%CI 0.419~0.772;AUC=0.603,95%CI 0.446~0.744)。术前额面QRS-T夹角水平与MACE星正相关(r=0.596,P=0.003),而△(术前-术后)与MACE呈负相关(r=-0.483,P=0.012),Gensini积分与MACE呈正相关(r=0.445,P=0.023)。Logistic回归分析:Gensini积分和术前QRS-T角为MACE发生的独立危险因素(OR=1.19,95%CI 0.94~1.52;OR=1.76,95%CI 0.45~2.12)。结论 ACS息者额面QRS-T夹角明显升高,PCI术后出现回落。术前QRS-T夹角为MACE发生的独立危险因子。

Objective To investigate the changes of QRS-T angle in the patients with acute coronary syndrome（ACS） and its clinical significance.Methods 160 patients with ACS（ACS group） and 40 patients with non-coronary heart disease（control group）,in the ACS group,72 patients with unstable angina pectoris（L＇AP group）,48 patients with non ST segment elevation myocardial infarction（NSTEM1 group）,40 patients with ST segment elevation myocardial infarction（STEMI）.According to the Gensini score to evaluate the severity of coronary artery disease,patients were divided into mild sub group（Gensini score less than or equal to 20 points） with 36 cases,90 cases of moderate subgroup（20 points Gensini score less than or equal to 40）,and 34 cases of severe subgroup（Gensini score 40 points）.Comprehensive analysis ACS patients before and after PCI＇s frontal QRS-T angle changes and relationship with major adverse cardiac events（MACE）.Results ACS group before PCI,the QRS-T forehead angle were significantly higher than the control group（F =5.182,P =0.023）.STEMI subset＇s QRS-T angle was obviously higher than that of the UAP subgroup patients（t = 1.819,P =0.039）;STEMI subgroup patients after PCI,the QRS-T angle decreased significantly（t =1.761,P =0.041）.The preoperative average Gensini score in STEMI subgroup,NSTEMI subgroup were higher than that of UAP subgroup（t = 1.822,t =1.939,P〈0.05）.Postoperative follow-up,STEMI subgroup,NSTEMI subgroup＇ s MACE events occur rate were lower than the UAP subgroup（χ^2 = 1.905,χ^2 = 2.541,P〈0.05）.Moderate subgroup and severe subgroup patients＇ QRS-T forehead angle was significantly higher than that of mild subgroups（P〈0.05）.Compared with the preoperative,after PCI,only severe subgroup＇s QRS-T angle significantly decreased（t =1.801,P =0.040）.Severe subgroup patients＇ MACE was significantly higher than mild and moderate subgroup（P〈0.05）.Preoperative and A（preoperative-postoperative） QRS-T angle＇s level has certain diagnostic predictive value for MACE occurrence（AUC = 0.632,95%CI 0.419- 0.772;AUC = 0.603,95%CI 0.446-0.744）.Before PCI＇s QRS-T angle＇s level was correlated with MACE（r =0.596,P =0.003）,and A（preoperative and postoperative） and MACE was negative correlated（r =-0.483,P =0.012）,Gensini score and MACE were positively correlated（r =0.445,P =0.023）.Logistic regression analysis;Gensini score and preoperative QRS-T angle were independent risk factors for MACE（OR = 1.19,95%CI 0.94-1.52;OR = 1.76,95%CI 0.45-2.12）.Conclusion The QRS-T angle of ACS patients was significantly increased,and after PCI was decreased.The before PCI＇s QRS-T angle was independent risk factor for MACE.