急性心肌梗死患者右胸及后壁心电图变化对心脏不良事件再发的影响

Effect of electrocardiogram changes in right chest and posterior wall on the recurrence of adverse cardiac events in patients with acute myocardial infarction

目的探究急性心肌梗死(AMI)患者右胸及后壁心电图变化对心脏不良事件再发的影响。方法回顾性分析2019年11月至2021年11月西安市人民医院收治的91例AMI患者的临床诊治资料,按是否再发心脏不良事件分组,其中21例再发心脏不良事件患者纳入心脏不良事件组,70例未再发心脏不良事件患者纳入对照组。比较两组患者的临床资料、右胸及后壁心电图变化情况,采用多因素Logistic回归方法分析心脏不良事件再发的独立影响因素。结果心脏不良事件组患者的心率(HR)、吸烟人群分别为(90.97±23.63)次/min、71.43%,明显高于对照组的(73.95±12.56)次/min、42.86%,平均动脉压(MAP)为(83.11±24.11)mmHg,明显低于对照组的(89.91±15.24)mmHg,差异均有统计学意义(P<0.05);心脏不良事件组患者的QV7>0.03 s、QV8>0.04 s、V7Q/R>1/3、V8Q/R>1/2、RV2=0.04 s、ST段弓背或凹面向上或水平下移≥0.05 mV及TV1>0.4 mV患者占比明显高于对照组,差异均有统计学意义(P<0.05);心脏不良事件组患者肌酐、N-末端脑钠肽前体(NT-proBNP)、低密度脂蛋白胆固醇(LDL-C)、肌酸激酶(CK)、心肌型肌酸激酶同工酶(CK-MB)明显高于对照组,差异均有统计学意义(P<0.05);经多因素Logistic回归分析结果显示,QV8>0.04 s、V7Q/R>1/3、RV2=0.04 s、ST段弓背或凹面向上或水平下移≥0.05 mV与吸烟史均是心脏不良事件再发的独立影响因素(P<0.05)。结论右胸及后壁心电图变化与AMI患者心脏不良事件再发的风险密切相关,临床应密切监测患者右胸及后壁心电图变化。

Objective To investigate the influence of electrocardiogram(ECG)changes in right chest and posterior wall on recurrence of adverse cardiac events in patients with acute myocardial infarction(AMI).Methods The clinical data of 91 patients with AMI admitted to Xi'an People's Hospital from November 2019 to November 2021 were retrospectively analyzed.According to the occurrence of adverse cardiac events,the patients were divided into adverse cardiac events group(with recurrence of adverse cardiac events,n=21)and control group(without recurrence of adverse cardiac events,n=70).The clinical data and ECG changes in right chest and posterior wall were compared between the two groups.The independent influencing factors for recurrence of adverse cardiac events were analyzed by multivariate logistic regression.Results Heart rate(HR)and smoking population in the adverse cardiac events group were(90.97±23.63)times/min and 71.43%,respectively,which were significantly higher than(73.95±12.56)times/min and 42.86%in the control group;the mean arterial pressure(MAP)was(83.11±24.11)mmHg,which was significantly lower than(89.91±15.24)mmHg of the control group;the differences were statistically significant(P<0.05).The proportion of QV7>0.03 s,QV8>0.04 s,V7Q/R>1/3,V8Q/R>1/2,RV2=0.04 s,upward or downward movement of ST segment≥0.05 mV,and TV1>0.4 mV in adverse cardiac events group were significantly higher than those in the control group(P<0.05).Creatinine,N-terminal pro-brain natriuretic peptide(NT-proBNP),low-density lipoprotein cholesterol(LDL-C),creatine kinase(CK),creatine kinase MB(CK-MB)in adverse cardiac events group were significantly higher than those in the control group(P<0.05).Logistic regression analysis showed that QV8>0.04 s,V7Q/R>1/3,RV2=0.04 s,upward or downward movement of ST segment≥0.05 mV,and smoking history were all independent influencing factors for recurrence of adverse cardiac events(P<0.05).Conclusion The ECG changes of right chest and posterior wall are closely related to the risk of recurrence of adverse cardiac events in AMI.It is necessary to closely monitor ECG of right chest and posterior wall in patients.