心电图对非ST段抬高型急性冠状动脉综合征患者危险分层中的临床价值

Clinical value of electrocardiogram in risk stratification of patients with non-ST segment elevation acute coronary syndrome

目的:探讨心电图对非ST段抬高型急性冠状动脉综合征(ACS)患者危险分层中的临床价值。方法:选取260例非ST段抬高型ACS患者,依据患者心电图情况的改变,将其分为心电图无法确诊组(22例)、单纯T波倒置组(40例)、ST段压低组(118例)和心电图正常组(80例)。对4组患者行常规18导联心电图检查和肌钙蛋白I(TnI)检测,观察4组患者住院及随访期间的心血管事件发生情况。结果:ST段压低组复合心血管事件及反复心绞痛发作与心电图正常组比较明显增多,其差异有统计学意义(x^2=5.723,x^2=15.680;P<0.05)。多因素Logistic回归分析显示,TnI阳性因素预测复合心血管事件的独立价值较高。结论:非ST段抬高型ACS患者通过心电图ST段变化及TnI水平可有效进行危险分层,并对心血管事件进行预测,具有较高的临床应用价值,其中TnI阳性的独立预测性更高。

Objective： To investigate the clinical value of electrocardiogram in risk stratification of patients with non-ST segment elevation acute coronary syndrome（ACS）. Methods： According to the change of electrocardiogram, 260 patients with non-ST segment elevation ACS were divided into four groups： ECG-undiagnosed group（n=22）, T-wave inversion group（ST-segment depression group）, ST-segment depression group（n=118） and normal electrocardiogram group（n=80）. All patients were treated with conventional 18-lead electrocardiogram and troponin I（Tn I）detection in the four groups. The incidence of cardiovascular events during and after hospitalization was observed. Results： The complex cardiovascular events and recurrent angina attacks in ST segment depression group increased significantly than that in normal ECG group. The difference was statistically significant（x^2=5.723, x^2=15.680; P〈0.05）. Multivariate logistic regression analysis showed that Tn I positive factors predict the independent value of composite cardiovascular events higher. Conclusion： The patients with ST segment elevation acute coronary syndrome can effectively carry out risk stratification by ECG ST-segment changes and Tn I levels, and predict the cardiovascular events. It has higher clinical application value and independent predictive value of Tn I positive.