急性心肌梗死患者PCI术前后心电图QRS-T夹角变化及其预后价值

Analysis of QRS-T Angel Before and after PCI in Acute Myocardial Infarction and Its Prognosis Value

目的:探讨急性心肌梗死患者(AMI)PCI术前、后心电图QRS-T夹角的变化以及在预后评估中的价值。方法:选择2016年7月-2018年8月期间于我院行经皮冠状动脉介入治疗(PCI)的115例AMI患者为实验组,并根据Gensini积分分为低度、中度及高度狭窄亚组,在患者PCI术后对其进行随访,随访时间为12个月。并选取同期于我院就诊的非AMI患者38名作为对照组,比较两组患者的一般资料和术前QRS-T夹角;AMI各亚组间术后24 h内的QRS-T夹角变化及12个月累积主要不良心血管事件(MACE)发生情况。应用Pearson模型和Cox回归模型分析QRS-T夹角与MACE的相关性及MACE发生的危险因素。结果:实验组PCI术前QRS-T夹角明显大于对照组;实验组各亚组PCI术后24 h内的QRS-T夹角均较各自术前降低,且随着各亚组AMI冠脉病变程度依次加重,术前及术后QRS-T夹角值均依次增大,差异均有统计学意义(P<0.05);并且低度亚组和中度亚组的MACE的发生率明显低于高度亚组(χ^(2)=14.12,P=0.001);Gensini积分、PCI术前及术后24h内的QRS-T夹角均与MACE呈正相关,差异均有统计学意义(P<0.05);多因素Cox回归分析显示,Gensini积分(HR=1.015,P=0.024)和术前QRS-T夹角(HR=1.009,P=0.027)是急性AMI患者发生MACE的危险因素。结论:Gensini积分和术前QRS-T夹角是AMI患者发生MACE的危险因素,术前QRS-T夹角对AMI的预后有较好的预测评估价值。

Objective:To investigate the changes of QRS-T angle before and after percutaneous coronary intervention(PCI)in patients with acute myocardial infarction(AMI)and its value in evaluating the prognosis.Methods:115 MI patients who underwent PCI in our hospital from July 2016 to August 2018 were selected as the treatment group and divided into low,middle and high narrow sub-groups and followed by 12 months follow-up,while 38 non-AMI patients underwent physical examination were selected as the control group.The general data and preoperative QRS-T angle between the two groups,the changes of QRS-T angle within 24 hours after operation and the cumulative occurrence of major adverse cardiovascular events(MACE)in 12 months were compared between the two groups.Pearson model and Cox regression model were used to analyze the correlation between QRS-T angle and MACE and;the risk factors of MACE.Results:QRS-T angel before PCI was significantly higher in the treatment group than the control group and increased with disease severity both before and after PCI.QRS-T angel decreased 24 h after PCI among the three sub-groups(P<0.05)12 months’MACE increased significantly in high narrow group than the other two groups(χ^(2)=14.12,P=0.001).Gensini score and QRS-T angel before and 24 h after PCI were positively correlated with MACE significantly(P<0.05).Multivariate Cox regression showed Gensini score(HR=1.015,P=0.024)and QRS-T angel(HR=1.009,P=0.027)before PCI were risk factors of MACE.Conclusion:In AMI patients,Gensini score and QRS-T angel before PCI are risk factors of MACE.QRS-T angel before PCI has a good predictive value for the prognosis of acute myocardial infarction.