Objective To explore the significance of early ST -segment changes in STEMI patients after emergent percutaneous coronary intervention( PCI) . Methods The study enrolled 48 STEMI patients who underwent emergent PCI in Peking University Aerospace School of Clinical Medicine from April 2011 to April 2013. According to ST -segment resolution within 60 minutes after PCI,the subjects were divided into resolution group( ST - segment resolution≥50%)and non -resolution group(ST-segment resolution<50%). Comparison was made between the two groups in basic information(gender, age,medical history,biochemical criterion and clinical examination),ST -segment resolution,operation data( onset time, pain-gate time,gate -ball time,operation time and the incidence rates of ST -segment resolution within 60 minutes after operation,postoperative TIMI blood flow 0. 05)in LVEF and the number of segments with abnormal wall motion. The echocardiography before discharge showed that the resolution group was higher( P<0. 05)in LVEF and was lower(P<0. 05)in EDV than non-resolution group;the two groups were not significantly different in E/A(P>0. 05). The resolution group was lower(P<0. 05)than non-resolution group in the incidence rates of arrhythmia, heart failure and MACE;the two groups were not significantly different( P >0. 05 ) in the incidence rates of angina. The resolution group was lower than non-resolution group in the total incidence rates of malignant arrhythmia,heart failure,angina following myocardial infarction,major adverse cardiovascular events and composite cardiovascular events(χ2 =32. 643,30. 643, 33. 296,4. 023,30. 468;P = 0. 001 ). Conclusion The STEMI patients with early ST - segment resolution have lower incidence of total cardiovascular events,by which the short-term prognosis of STEMI patients can be well predicted,and the early ST-segment resolution usually occur within 30 minutes after PCI. And the finding may provide reference for further clinical research.%目的：探讨急性ST段抬高型心肌梗死（ STEMI）患者行急诊经皮冠状动脉介入（ PCI）术后早期ST段变化的临床意义。方法2011年4月—2013年4月选取在北京大学航天临床医学院住院行急诊 PCI术的48例急性STEMI患者。根据PCI术后60 min内ST段回落情况将患者分为回落组（ ST段回落≥50%）和非回落组（ ST段回落<50%）。比较两组患者基本信息（包括性别、年龄、病史、生化指标、临床检查等）、ST段回落情况和手术资料〔发病时间、痛门时间、门球时间、手术时间、术后60 min后ST段抬高发生率、术后心肌梗死溶栓治疗（ TIMI）血流分级<3级发生率、单支病变发生率、两支病变发生率、三支病变发生率、左前降支（ LAD ）病变发生率、左回旋支（ LCX）病变发生率、右冠状动脉（ RCA）病变发生率〕、PCI术前左心室造影心脏参数〔左心室射血分数（ LVEF）、室壁异常运动节段数〕和出院前心脏超声心脏参数〔舒张末期容积（ EDV）、LVEF、E峰与A峰流速比值（ E/A）〕、出院后1年心血管事件发生率并进行生存分析。结果患者中回落组28例，非回落组20例。两组患者男性比例、Killip分级（≥2级）、年龄、心率（HR）、肌酸激酶（CK）、肌酸激酶同工酶（CK-MB）比较，差异有统计学意义（ P<0.05）。PCI术后60 min内心电图示：回落组28例患者ST段回落，非回落组20例患者未出现ST段回落。两组患者PCI术后60 min后ST段抬高发生率、PCI术后TIMI血流分级<3级发生率比较，差异有统计学意义（ P<0.05）。PCI术前左心室造影示：两组患者LVEF、室壁异常运动节段数比较，差异无统计学意义（ P>0.05）。出院前心脏超声示：回落组患者LVEF高于非回落组，EDV低于非回落组（ P<0.05）；两组患者E/A比较，差异无统计学意义（ P>0.05）。回落组患者心律失常事件发生率、心力衰竭事件发生率、主要不良心脏事件（ MACE）发生率均低于非回落组（P<0.05）；两组患者心肌梗死后心绞痛事件发生率比较，差异无统计学意义（P>0.05）。回落组心律失常事件累计发生率、心力衰竭事件累计发生率、心肌梗死后心绞痛事件累计发生率、MACE累计发生率及复合心血管事件累计发生率均低于非回落组（χ2=32.643、30.643、33.296、4.023、30.468，P =0.001）。结论早期 ST 段回落的急性STEMI患者1年心血管事件累积发生率较低，能较好预测其近期预后，且早期ST段回落时间均在30 min内，为临床进一步研究提供参考。
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