动态心电图对经皮冠状动脉介入治疗后急性心肌梗死患者预后的预测价值

Predictive value of the ambulatory electrocardiogram in the prognosis of patients with acute myocardial infarction after percutaneous coronary intervention

目的:评价动态心电图对经皮冠状动脉介入治疗(PCI)后急性心肌梗死患者预后的预测价值。方法:回顾性分析2021年1月—2022年10月于同济大学附属东方医院胶州医院行PCI的急性心肌梗死177例的临床资料。根据PCI后12个月是否发生主要心血管不良事件将患者分为预后不良组与预后良好组,观察其入院时动态心电图检查参数[震荡初始(TO)、震荡斜率(TS)、窦性R-R期间总体标准差(SDNN)、QT离散度(QTd)、校正QT离散度(QTcd)],并分析动态心电图对PCI后急性心肌梗死患者预后的预测效能。结果:随访期间,177例中有45例发生主要心血管不良事件,发生率为25.42%,为预后不良组;132例未发生主要心血管不良事件,为预后良好组。预后不良组TS、SDNN低于预后良好组,差异有统计学意义(P<0.05);两组TO、QTd、QTcd比较,差异无统计学意义(P>0.05)。ROC曲线分析结果显示TS和SDNN预测PCI后急性心肌梗死患者预后的曲线下面积(AUC)分别为0.776、0.635,两者联合预测的AUC为0.885。结论:动态心电图对PCI后急性心肌梗死患者的预后有较好预测价值,其中以TS和SDNN联合预测效能较高。

Objective To evaluate the predictive value of dynamic electrocardiography for the prognosis of patients with acute myocardial infarction after percutaneous coronary intervention(PCI).Methods The clinical data of 177 patients with acute myocardial infarction who underwent PCI in Jiaozhou Hospital,Dongfang Hospital,Tongji University from January 2021 to October 2022 were retrospectively analyzed.Patients were divided into poor prognosis group and good prognosis group according to whether major adverse cardiovascular events occurred 12 months after PCI.The parameters[initial oscillation(TO),oscillation slope(TS),overall standard deviation of sinus R-R intervals(SDNN),QT dispersion(QTd),corrected QT dispersion(QTcd)]of holter were observed at admission,and the predictive efficacy of holter on prognosis of patients with acute myocardial infarction after PCI was analyzed.Results During the follow-up period,45 cases out of 177 patients experienced major adverse cardiovascular events,with an incidence rate of 25.42%,and were classified as the poor prognosis group.132 patients did not experience major adverse cardiovascular events and were classified as the good prognosis group.The TS and SDNN of the poor prognosis group were lower than those of the good prognosis group,and the difference was statistically significant(P<0.05).There was no statistically significant difference in TO,QTd,and QTcd between the two groups(P>0.05).ROC curve analysis showed that the area under the curve(AUC)for predicting the prognosis of patients with acute myocardial infarction after PCI was 0.776 and 0.635,respectively,and the combined prediction of both had an AUC of 0.885.Conclusions Dynamic electrocardiography has a high predictive value for the prognosis of patients with acute myocardial infarction after PCI,with the combination of TS and SDNN showing higher predictive efficacy.