冠状动脉介入对QRS波终末变形的心肌梗死患者预后的影响

The influence of percutaneous coronary intervention on the prognosis of acute myocardial infarction with distortion of terminal portion of the QRS wave

目的 :探讨伴有QRS波终末变形的急性心肌梗死 (AMI)患者经皮冠状动脉 (冠脉 )介入 (PCI)及梗死相关冠脉再通时间对其预后的影响。方法 :将 2 38例初发AMI患者按是否行PCI治疗分为PCI组及非PCI组 ;两组中根据心电图QRS波终末变形分为QRS +(qR型导联的J点抬高 >5 0 % ,R波或Rs型导联的s波消失 )及QRS - ;PCI组中又分为急诊PCI(起病后 12h内行PCI)及择期PCI两亚组。比较QRS +急诊PCI亚组与其他组住院期间死亡率及随访期间 [平均 (12 .6 5± 1.4 6 )个月 ]死亡率、超声心动图左室射血分数 (LVEF)、LVEF <4 0 %的例数、左室舒张期内径 (LVD)等。结果 :急诊PCI的QRS +患者住院期间死亡率明显低于非PCI的QRS+患者 (P <0 .0 5 ) ;前者随访期死亡率明显低于、LVEF明显大于择期PCI及非PCI的QRS +患者 ;且LVEF <4 0 %的例数及LVD值明显低于择期PCI及非PCI的QRS +患者 (均P <0 .0 5 )。结论 :QRS波终末变形的AMI患者的预后与相关冠脉是否及时再通有关 。

Objective: To evaluate the long term influence of percutaneous coronary intervention (PCI) on acute myocardial infarction(AMI) patients with distortion of terminal portion of the QRS wave. Method: Divided 238 AMI patients into PCI group (all the patients had received PCI) and Non PCI group. Within the two groups, the patients were divided into QRS+(with distortion of terminal portion of the QRS wave)and QRS-groups. Then the patients were sub-divided into emergent PCI groups (patients who received emergent PCI) and non-emergent PCI groups. The in-hospital and follow-up mortalities were compared between the groups . Within the follow-up period, the left ventricular ejection fraction(LVEF), and the left ventricular dimension (LVD) among the groups were compared. Result: The in-hospital mortality was less in the QRS+ patients received emergent PCI(EPQRS+) than that of the QRS+ patients who did not receive PCI(NPQRS+)(P< 0.05). The follow-up mortality in EPQRS+ was less than those in NPQRS+ and the patients with QRS+ without emergent PCI(NEPQRS+) (P< 0.05). LVEF was higher(P< 0.05), the number of LVEF<40% was less(P< 0.05) and the LVD was smaller(P< 0.05) in the EPQRS+ group than those in NPQRS+ and NEPQRS+ groups. Conclusion: By emergent PCI and early reperfusion of infarct related coronary artery, the QRS+ patients have a better prognosis.