不同类型急性心肌梗死患者行直接经皮冠状动脉介入治疗术中心律失常发生情况比较

Comparison of the incidence of arrhythmia in patients with different types of acute myocardial infarction undergoing direct percutaneous coronary intervention

目的比较分析非ST段抬高型心肌梗死（NSTEMI）和ST段抬高型心肌梗死（STEMI）患者行直接经皮冠状动脉介入治疗（PCI）术中心律失常的发生情况。方法选取行直接PCI术的急性心肌梗死（AMI）患者294例，其中STEMI患者181例（STEMI组）和NSTEMI患者113例（NSTEMI组），回顾性分析两组患者PCI术中心律失常、再灌注心律失常（RA）及术后1个月内主要不良心血管事件的发生情况。结果STEMI组96例（53．04％）患者发生心律失常，其中90例（49．72％）为RA；NSTEMI组23例（20．35％）患者发生心律失常，其中6例（5．31％）为RA，STEMI组发生心律失常及RA患者比例高于NSTEMI组（P〈0．01）。STEMI组和NSTEMI组梗死相关动脉（IRA）为右冠状动脉（RCA）和回旋支（LCX）发生缓慢型心律失常患者比例均高于前降支（LAD），STEMI组IRA为LAD发生快速型心律失常患者比例高于RCA（P〈0．01或P〈0．05），而NSTEMI组IRA为LAD、LCS及RCA发生陕速型心律失常患者比例比较，差异无统计学意义（P〉0．05）。术后1个月两组发生心力衰竭、心源性休克、恶性心律失常、急性／亚急性血栓形成、再次心肌梗死、再次血运重建及心源性死亡患者比例比较，差异均无统计学意义（P〉0．05）。结论STEMI患者直接PCI术中心律失常的发生率明显高于NSTEMI患者。

Objective To compare and analyze the incidence of arrhythmia in patients with non-ST segment elevation myocardial infarction（NSTEMI） and ST segment elevation myocardial infarction（STEMI） undergoing direct percutaneous coronary intervention（PCI）. Methods A total of 294 patients with acute myocardial infarction（AMI） who underwent direct PCI were selected and there were 181 patients with STEMI（STEMI group） and 113 patients with NSTEMI （NSTEMI group）. The incidence of arrhythmia, reperfusion arrhythmia（RA） during PCI and major adverse cardiovascular events within 1 month after PCI in the two groups were retrospectively analyzed. Results Arrhythmias occurred in 96 patients （53.04%） and RA occurred in 90 patients（49.72% ） in STEMI group. Arrhythmias occurred in 23 patients（20.35% ） and RA occurred in 6 patients（5.31% ） in NSTEMI group. Rates of patients with arrhythmia and RA in STEMI group were higher than those in NSTEMI group （P 〈 0.01 ）. Rates of patients with bradyarrhythmias whose infarction related artery（IRA） were fight coronary artery（RCA） and circumflex artery（LCX） were higher than anterior descending artery（LAD） in STEMI group and NSTEMI group and rate of patients with tachyarrhythmias whose IRA were LAD was higher than RCA in STEMI group（P 〈0.01 or P 〈0.05）. But rates of patients with tachyarrhythmias between whose IRA were LAD, LCX and RAD were not significantly different in NSTEMI group（ P 〉 0.05 ）. There were no significant differences in rates of patients with heart failure, cardiogenic shock, malignant arrhythmia, acute/subacute thrombosis, remyocardial infarction, revascularization and cardiac death between the two groups 1 month after PCI （P 〉 0. 05）. Conclusion The incidence of arrhythmia during direct PCI in STEMI patients is significantly higher than that in NSTEMI patients.