ST段抬高型心肌梗死患者直接PCI术后Q波发生情况及对预后的影响

The occurrence of Q wave and its influence on prognosis of patients with ST-segment elevation myocardial infarction after direct PCI

目的探讨急性ST段抬高型心肌梗死(STEMI)患者直接PCI术后Q波发生情况及其对预后的影响。方法选取STEMI行直接PCI术后心电图上可见Q波的患者108例,排除既往心肌梗死病史和冠状动脉血运重建术患者。随访3年,通过logistic回归分析影响这108例患者Q波出现的因素,并通过Cox回归分析Q波与死亡和心血管事件之间的关系。结果男性、STB时间以及吸烟是影响Q波出现的独立危险因素。PCI术后出现Q波的患者具有更高的全因死亡率(Rr=1.38,95%CI 1.01～2.02,P<0.001)和心血管死亡率(Rr=1.65,95%CI 1.02～2.64,P<0.001)。Q波与心源性死亡之间的关系不受性别(Rr=1.58,95%CI0.76～3.22,P=0.38),糖尿病(Rr=2.52,95%CI 1.08～5.72,P=0.51),靶血管(Rr=2.14,95%CI 1.11～4.08,P=0.82)或者门-球时间(Rr=1.72,95%CI0.92～3.21,P=0.88)的影响。结论男性、STB时间以及吸烟是影响Q波出现的独立危险因素,Q波可以作为独立预测STEMI患者直接行PCI术预后的因子。

Objective To investigate the occurrence of Q wave and its influence on prognosis of patients with ST-segment elevation myocardial infarction (STEMI) after direct PCI. Methods A total of 108 patients with STEMI who underwent direct PCI and had Q wave on ECG were enrolled in the study,who had no history of previous myocardial infarction and coronary revascularization.After 3-year follow-up,the factors affecting the Q wave were analyzed by Logistic regression,and the relationship between Q wave and death as well as cardiovascular events was analyzed by Cox regression. Results The male,STB time and smoking were independent risk factors for Q wave emergence.The patients with Q wave after PCI had higher all-cause mortality (R r =1.38,95% CI 1.01~2.02, P <0.01) and cardiovascular mortality (Rr =1.65,95% CI 1.02 ~2.64), P <0.01).The relationship between Q wave and cardiogenic death was not affected by gender (R r =1.58,95% CI0.76~3.22, P>0.05),diabetes (Rr =2.52,95% CI 1.08~5.72, P>0.05),target vessels (R r =2.14,95% CI 1.11 ~4.08, P >0.05) or gate-to-ball time (R r =1.72,95% CI 0.92~3.21, P >0.05). Conclusion The male,STB time and smoking are independent risk factors for the occurrence of Q wave,and Q wave can be regarded as a predictor of prognosis in patients with STEMI after direct PCI.