术前血清cTnI水平与心电图fQRS预测ST段抬高型心肌梗死患者PCI术后ST段回落的价值

Value of Preoperative Serum cTnI Level and Electrocardiographic fQRS in Predicting ST-segment Fall in Patients with ST-segment Elevation Myocardial Infarction after PCI

目的探究术前血清肌钙蛋白I(c Tn I)水平与心电图碎裂QRS(f QRS)波在预测ST段抬高型心肌梗死(STEMI)患者经皮冠状动脉介入(PCI)术后ST段回落的价值。方法回顾性分析我院124例行PCI治疗的STEMI患者的临床资料,根据患者PCI术后60 min与术前相比ST段回落情况分为ST段回落≥50%组(回落良好组)及ST段回落<50%组(回落不良组)。比较2组术前f QRS波发生率、血清c Tn I水平,使用Kappa系数分析术前f QRS波与PCI术后ST段回落不良的一致性,采用受试者工作特征(ROC)曲线评估术前血清c Tn I水平对PCI术后ST段回落不良的预测价值;并记录术后TIMI血流分级、术后3个月内主要心血管不良事件(MACE)发生率。结果124例患者回落良好组85例(68.55%),回落不良组39例(31.45%),2组性别、年龄、责任血管、合并高血压、糖尿病、吸烟史情况及甘油三酯、胆固醇、高密度脂蛋白胆固醇、低密度脂蛋白胆固醇水平比较,差异无统计学意义(P>0.05);回落不良组肌酸激酶、肌酸激酶同工酶及左心室舒张末期容积显著高于回落良好组(P<0.05),左室射血分数则低于回落良好组(P<0.05)。回落不良组术前f QRS波发生率及血清c Tn I水平均高于回落良好组(P<0.05)。术前f QRS波与PCI术后ST段回落不良具有中度一致性,Kappa系数为0.541。经ROC曲线分析,发现术前血清c Tn I水平对PCI术后ST段回落不良具有较高预测价值(AUC=0.909,P<0.05),其cut-off值为2.375 ng/ml。回落不良组术后TIMI血流分级<3级及术后3个月MACE总发生率均高于回落良好组(P<0.05)。结论术前血清c Tn I水平与f QRS情况对预测STEMI患者PCI术后ST段回落有利,临床可在术前联合监测上述2项指标,以尽早判断疗效及预后,为STEMI患者制定更为个性化的干预策略。

Objective To explore the value of preoperative serum troponin(cTnI) level and electrocardiographic fragmented QRS wave(fQRS) in predicting ST-segment fall in patients with ST-segment elevation myocardial infarction(STEMI) after percutaneous coronary intervention(PCI). Methods A retrospective analysis was performed on the clinical data of 124 patients with STEMI who underwent PCI in our hospital. The patients were divided into ST-segment fall ≥50% group(good fall group) and ST-segmentfall<50% group(poor fall group) based on the ST-segment fall at 60 min after PCI compared with before surgery. The incidence rate of preoperative fQRS wave, serum cTnI level were compared between the two groups. Kappa coefficient was used to analyze the consistency of preoperative fQRS wave and poor ST-segment fall after PCI, and receiver operating characteristic(ROC) curve was used to evaluate the predictive value of preoperative serum cTnI level on poor ST-segment fall after PCI. The postoperative TIMI blood flow classification and incidence rates of major adverse cardiovascular events(MACE) within 3 months after surgery was recorded in the two groups. Results There were 85 cases(68.55%) in good fall group and 39 cases(31.45%) in poor fall group among 124 patients. There were no significant differences between the two groups in terms of gender, age, offending vessel, hypertension, diabetes, smoking history, and levels of triglyceride, cholesterol, high density lipoprotein cholesterol, low density lipoprotein cholesterol(P>0.05). Creatine kinase, creatine kinase isoenzyme, and left ventricular end-diastolic volume in poor fall group were significantly higher than those in good fall group(P<0.05), while left ventricular ejection fraction was lower than that in good fall group(P<0.05). The incidence rate of preoperative fQRS wave and serum cTnI level in poor fall group were higher than those in good fall group(P<0.05). The preoperative fQRS wave is moderately consistent with poor ST-segment fall after PCI, and the Kappa coefficient was 0.541. After ROC curve analysis, it was found that the preoperative serum cTnI level had a higher predictive value on poor ST-segment fall after PCI(AUC=0.909, P<0.05), and its cut-off value was 2.375 ng/ml. The incidence rate of postoperative TIMI blood flow classification<grade 3 and total incidence rate of MACE at 3 months after surgery in poor fall group were higher than those in good fall group(P <0.05). Conclusion Preoperative serum cTnI level and fQRS status are beneficial to predict ST-segment fall in STEMI patients after PCI. It is necessary to jointly monitor the above two indicators before surgery so as to determine the efficacy and prognosis as early as possible, and to develop more personalized intervention strategy for STEMI patients.