梗死区Tp-ec及Tp-e/QT值对ST段抬高型心肌梗死患者的预后价值分析

Prognostic value analysis of infarcted zone Tp-ec and Tp-e/QT in patients with ST-segment elevation myocardial infarction

目的探讨梗死区矫正的T波峰末间期(Tp-ec)、T波峰末间期与QT间期比值(Tp-e/QT)对ST段抬高型心肌梗死(STEMI)患者的预后价值。方法回顾性分析住院诊断为STEMI的患者281例,其中院内主要心脏不良事件(MACE)组36例,非MACE组245例。比较两组一般临床资料、经皮冠状动脉介入治疗(PCI)术前及术后Tp-ec及Tpe/QT值的差异,采用二分类因变量的Logistic回归分析和受试者工作曲线(ROC)分析筛选出STEMI患者发生MACE的危险因素及预测因子。结果与非MACE组比较,MACE组患者年龄偏高,心率增快,门球时间较长,女性比例和多支病变比例增高,术后TIMI血流3级比例降低,左室射血分数(LVEF)降低。单因素分析显示MACE组PCI术前及术后Tp-ec、Tp-e/QT值较非MACE组高,差异有统计学意义(P<0.05)。二分类Logisitic回归分析显示,PCI术前Tp-e/QT(OR=1.238,P<0.001)、LVEF(OR=0.924,P=0.005)、门球时间(OR=1.007,P=0.018)是STEMI患者发生MACE的独立危险因素。术前Tp-ec、Tp-e/QT的ROC曲线下面积(AUC)分别为0.817(95%CI 0.763~0.864)、0.889(95%CI 0.843~0.926)。Z检验显示,术前Tp-e/QT的AUC与术前Tp-ec、术后Tp-ec、术后Tp-e/QT的AUC差异有统计学意义(P<0.05)。结论术前Tp-e/QT是STEMI患者院内MACE发生的独立危险因素,术前Tp-ec、Tp-e/QT对MACE预测价值较高。

Objective To evaluate the prognostic value of infarcted zone Tp-ec and Tp-e/QT in patients with Stsegment elevation myocardial infarction.Methods A retrospective analysis was made of 281 patients diagnosed as STEMI.Among them,36 were in the main adverse cardiac events(MACE)group and 245 were in the non-MACE group.The differences of Tp-ec and Tp-e/QT values before and after percutaneous coronary intervention(PCI)were compared between the two groups.The risk factors and predictors of MACE in STEMI patients were screened by binary Logistic regression analysis and ROC analysis.Results Compared with non-MACE group,MACE group had higher age,faster heart rate,longer door-to-balloon time,higher proportion of women and multiple vessel lesions,lower TIMI blood flow grade 3 ratio and lower left ventricular ejection fraction(LVEF).Univariate analysis showed that the Tp-ec and Tp-e/QT values of MACE group before and after PCI were higher than those of non-MACE group(P<0.05).Multivariate binary Logistic regression analysis showed that Tp-e/QT(OR=1.238,P<0.001),LVEF(OR=0.924,P=0.005)and door-to-balloon time(OR=1.007,P=0.018)were independent risk factors for MACE in STEMI patients before PCI.The area under ROC curve(AUC)was 0.817(95%CI 0.763~0.864)and 0.889(95%CI 0.843~0.926)respectively.Z test showed that the AUC of preoperative Tp-e/QT was significantly different from that of preoperative Tp-ec,postoperative Tp-ec and postoperative Tp-e/QT(P<0.05).Conclusion Preoperative Tp-e/QT is an independent risk factor for nosocomial MACE in STEMI patients.Preoperative Tp-ec and Tp-e/QT have higher predictive value for MACE.