平面QRS－T夹角对急性心肌梗死经皮冠状动脉介入治疗术后恶性室性心律失常的预测价值

Value of plane QRS-T angle on prediction of malignant ventricular arrhythmia occurred after emergency percutaneous coronary intervention in patients with acute myocardial infarction

目的分析急性ST段抬高型心肌梗死（STEMI）患者经皮冠状动脉介入治疗（PCI ）术后平面QRS-T夹角对恶性室性心律失常（MVA）的预测价值。方法回顾性分析418例症状发作12 h内行急诊PCI的STEMI患者的临床资料，并根据PCI术后平面QRS-T夹角的大小分为平面QRS-T夹角≤ 90°组（324例）和平面QRS-T夹角〉90°组（94例），比较两组临床资料的差异。结果与平面QRS-T夹角≤ 90°组相比，平面QRS-T夹角〉90°组年龄较大[（67.4 ± 11.8）岁比（63.6 ± 12.0）岁］，QTc间期延长[（438.60 ± 34.97）ms比（425.24 ± 25.49）ms]，左室射血分数（LVEF）〈45％比例升高[57.4% （54/94）比35.8%（116/324）] ，β受体阻滞剂使用比例降低［74.5% （70/94）比84.9%（275/324）]，而高血压和MVA发生率增高［79.8% （75/94）比64.5%（209/324）、10.6%（10/94）比1.2%（4/324）]，差异有统计学意义（P〈0.01或〈0.05）。Logistic回归分析显示STEMI患者PCI术后平面QRS-T夹角〉90°是MVA发生的危险因素（OR＝9.640，P＝0.001），使用β受体阻滞剂是MVA发生的保护因素（OR＝0.266，P＝0.028）。结论STEMI患者PCI术后平面QRS-T夹角〉90°是MVA发生的独立危险因素，而使用β受体阻滞剂则为保护因素。STEMI患者PCI术后平面QRS-T夹角〉90°且未使用β受体阻滞剂时，应当警惕MVA的发生。

Objective To analyze the value of plane QRS-T angle on prediction of malignant ventricular arrhythmia （MVA） occurred after emergency percutaneous coronary intervention （PCI） in patients with acute ST-segment elevation myocardial infarction （STEMI）. Methods The clinical data of 418 patients with STEMI who underwent PCI within 12 h of symptom onset were retrospectively analyzed, and the patients were divided into plane QRS-T angle≤ 90° group （324 cases） and plane QRS-T angle 〉 90° group （94 cases） according to the plane QRS-T angle after PCI. The clinical data were compared between 2 groups. Results Compared with patients in plane QRS-T angle ≤ 90°group, patients in plane QRS-T angle 〉 90° group was older： （67.4 ± 11.8） years vs. （63.6 ± 12.0） years, QTc interval was longer： （438.60 ± 34.97） ms vs. （425.24 ± 25.49） ms, rate of left ventricular ejection fraction （LVEF） 〈45% was higher： 57.4% （54/94） vs. 35.8% （116/324）, rate of using of beta-blockers was less： 74.5% （70/94） vs. 84.9% （275/324）, but the incidences of hypertension and MVA were higher： 79.8% （75/94） vs. 64.5% （209/324） and 10.6% （10/94） vs. 1.2% （4/324）, and there were statistical differences （P 〈 0.01 or 〈 0.05）. Logistic regression analysis showed that plane QRS-T angle 〉 90° was an independent risk factor of MVA after PCI in STEMI patients （OR = 9.640, P = 0.001）, and using of beta-blockers was a protective factor （OR = 0.266, P = 0.028）. Conclusions Plane QRS-T angle 〉 90± is an independent risk factor of MVA after PCI in STEMI patients, while the use of beta-blockers is a protective factor. Paients with STEMI after PCI should be alert to the occurrence of MVA in the condition of plane QRS-T angle 〉 90° and not taking beta-blockers.