心电图 aVR 导联 ST 段变化对急性冠脉综合征患者临床风险的预测价值研究

摘要

Objectjve To discuss the predictive value of ST - segment changes in ECG aVR lead for patients with acute coronary syndrome( ACS). Methods 446 ACS patients who were admitted to Department of Cardiology,the Third Hospital of Shijiazhuang from January 2009 to December 2012,were divided into three groups according to ST - segment changes in aVR lead:group 1( no change of ST - segment,n = 140),group 2( ST - segment elevation,n = 192)and group 3 (ST - segment depression,n = 114). The clinical informations of patients〔age,gender,heart rate,blood pressure,smoking history,history of high blood pressure,history of hyperlipidemias,history of diabetes,history of cardiac events( myocardial infarction and heart failure),levels of serum creatinine,levels of cardiac markers(CK,CK - MB and cTnI),type of ACS〕of cases were recorded. The hospital mortality risk score,hospital myocardial infarction risk score,mortality risk score 6 months after discharge,and myocardial infarction risk score 6 months after discharge were compared among three groups of patients according to global registry of acute coronary events(GRACE)risk score. Results There was no significant difference in age, heart rate,smoking rate,high blood pressure incidence,hyperlipemia incidence,diabetes incidence and rate of coronary artery bypass grafting among three groups of patients( P > 0. 05). There were significant differences in systolic pressure,levels of cardiac markers(CK,CK - MB and cTnI),gender,myocardial infarction incidence,incidences of three - coronary artery lesion and left main lesion,percutaneous coronary intervention rate among three groups of patients( P < 0. 05). There was significant difference in hospital mortality risk score among three groups(F = 10. 73,P < 0. 01). The hospital mortality risk score of group 1 was significantly lower than that of group 2( q = 15. 91,P < 0. 01). There was significant difference in hospital myocardial infarction risk score among three groups of patients( F = 12. 98,P < 0. 01) . The hospital myocardial infarction risk score of group 1 was significantly lower than that of group 2 and group 3,respectively(q = 25. 53,24. 01,P <0. 01). There was significant difference in mortality risk score 6 months after discharge among three groups(F = 19. 87,P <0. 01). The mortality risk score 6 months after discharge of group 1 was significantly lower than that of group 2(q = 13. 20,P <0. 01),the mortality risk score 6 months after discharge of group 2 was significantly higher than that of group 3(q = 15. 23,P <0. 01). There was significant difference in myocardial infarction risk score 6 months after discharge among three groups( F= 7. 81,P < 0. 01). The myocardial infarction risk score 6 months after discharge of group 2 was significantly higher than that of group 3(q = 13. 02,P < 0. 01). Conclusjon There is a predictive value for ST segment changes in ECG aVR lead for patients with ACS. The patients with ST - segment elevation have relatively poor prognosis.%目的：探讨体表心电图 aVR 导联 ST 段变化对急性冠脉综合征（ACS）患者临床风险的预测价值。方法选取2009年1月—2012年12月入住河北省石家庄市第三医院心血管内科的 ACS 患者446例，根据入院发病时aVR 导联 ST 段的变化分为1组（ST 段无变化，n =140）、2组（ST 段抬高，n =192）、3组（ST 段压低，n =114）。记录患者临床资料：包括年龄、性别、心率、血压、吸烟史、高血压病史、高脂血症病史、糖尿病病史、心脏事件史（心肌梗死、心力衰竭）、入院时血肌酐水平、心肌损伤标志物〔肌酸激酶（CK）、肌酸激酶同工酶（CK - MB）、肌钙蛋白 I（cTnI）〕水平、ACS 类型等。利用全球急性冠状动脉事件注册（GRACE）风险评分对3组患者院内死亡、心肌梗死风险评分及出院后院外6个月死亡、心肌梗死风险评分进行比较。结果3组患者年龄、心率、血肌酐、吸烟率、高血压患病率、高脂血症患病率、糖尿病患病率、行冠状动脉旁路移植术率比较，差异无统计学意义（ P >0.05）。3组患者收缩压、CK 水平、CK - MB 水平、cTnI 水平、性别、心肌梗死患病率、三支病变患病率、左主干病变患病率、行经皮冠状动脉介入术（PCI）率比较，差异有统计学意义（P <0.05）；3组患者院内死亡风险评分比较，差异有统计学意义（F =10.73，P <0.01）；1组患者院内死亡风险评分低于2组（q =15.91，P <0.01）。3组患者院内心肌梗死风险评分比较，差异有统计学意义（ F =12.98，P <0.01）；1组患者院内心肌梗死风险评分低于2、3组（ q=25.53、24.01，P <0.01）。3组患者院外6个月死亡风险评分比较，差异有统计学意义（ F =19.87，P <0.01）；1组患者院外6个月死亡风险评分低于2组（q =13.20，P <0.01）；2组患者院外6个月死亡风险评分高于3组（ q=15.23，P <0.01）。3组患者院外6个月心肌梗死风险评分比较，差异有统计学意义（F =7.81，P <0.01）；2组患者院外6个月心肌梗死风险评分高于3组（q =13.02，P <0.01）。结论心电图 aVR 导联 ST 段变化对 ACS 患者临床风险有预测价值，ST 段抬高患者预后相对较差。