急性心肌梗死患者直接PCI后心电图ST段回落与近期预后的关系研究

Relation between ST-segment resolution and proximal prognosis after primary PCI in patients with acute myocardial infarction

关键词:  心肌梗死  冠状动脉介入术  ST段  预后

Key words:  [Key words]　myocardial infarction  coronary intervention  ST-segment  prognosis

摘要:

[摘要]　目的　分析ST段抬高型急性心肌梗死（STEMI）直接经皮冠状动脉介入治疗（PCI）后心电图ST段早期回落和近期预后的相关性。　方法　STEMI患者140例，按PCI后2 h心电图相关导联ST段抬高总和较术前的下降百分比（ΣSTR）分为A组（ΣSTR≥50%，84例）和B组（ΣSTR＜50%，56例），比较两组患者PCI后梗死相关动脉（IRA）的TIMI血流分级、术后1周左心室射血分数(LVEF)及住院期间严重心脏不良事件（MACE）发生情况，对可能影响住院期间MACE的因素进行Logistic多因素回归分析。　结果　A组术后1周LVEF(54.1±5.1）%明显高于B组（46.7±4.0）%；住院期间MACE发生率A组(6.0%)显著低于B组(25.0%)，差异均有显著性意义，P＜0.05。影响MACE的Logistic多因素回归分析进入回归方程的有ΣSTR、发病至IRA再通时间、糖尿病史，ΣSTR贡献最大。　结论　急性STEMI患者直接PCI后心电图相关导联ST段的早期回落对PCI后的近期预后有重要的独立预测作用。

Abstract:

[Abstract]　Objective　To investigate the relationship between early ST-segment resolution magnitude and short term prognosis after successful primary PCI in ST-elevated AMI (STEMI) patients.　Methods　140 consecutive STEMI patients who underwent primary PCI were enrolled in this study. ST-segment resolution was calculated and the patients were divided into group A (n=84, ΣSTE resolved≥50%) and group B (n=56, ΣSTE resolved <50%). TIMI flow after PCI, clinical events 1~3 weeks after PCI and cardiac function about 7 days after PCI were assessed. Multifactor regression analysis was used to identify the factors that may affect major adverse cardiovascular events (MACE) in the in-hospital period.　Results　LVEF was higher in group A than that of group B, (54.1±5.1)% vs.( 46.7±4.0)%, P<0.05. The incidence of in-hospital MACE was also significantly less in group A than that in group B (6.0% vs. 25.0%, P<0.05). Multivariate regression analysis showed that ΣSTR、symptom-onset-to-coronary revisualization time and diabetes were independent predictors in hospital adverse outcomes.　Conclusion　Early ST-segment resolution after primary PCI is the strongest independent predictor in in-hospital adverse outcomes for STEMI patients.