心电图异常J波预测急性ST段抬高型心肌梗死患者短期预后的价值

摘要

Objective:To explore the relationship between abnormal ECG J wave and in‐hospital prognosis in patients with acute ST -segment elevation myocardial infarction (ASTEMI) .Methods :ECG and related clinical data of 204 ASTEMI patients ,who received emergency percutaneous coronary intervention (PCI) in our hospital from Jan 2007 to Dec 2012 ,were retrospectively analyzed .According to the presence of abnormal J wave or not ,patients were di‐vided into abnormal J wave group (n= 82 ,occupied 40.2% ,82/204) and no abnormal J wave group (n= 122 , 59.8% ,122/204) .Single‐and multiple‐factor Logistic regression analysis were used to analyze risk factors of in -hospital death .Results:During hospitalization ,incidence rate of sustained ventricular tachycardia/fibrillation in pa‐tients with abnormal ECG J waves was significantly higher than those without abnormal J waves (9.8% vs .1.6% , P=0.008) , but among the 12 cases (5.9% ) of cardiac deaths ,only six cases had abnormal J waves .Logistic regres‐sion analysis indicated that abnormal ECG J wave cannot predict in‐hospital death of ASTEMI patients (OR=0.99 , 95% CI :0.34~ 2.90 , P= 0.987) ,while age can be regarded as an independent predictor factor for in‐hospital prognosis of these patients (OR = 1.08 ,95% CI :1.01 ~ 1.15 , P= 0.02) .Conclusion:For ASTEMI patients , though the incidence rate of sustained ventricular tachycardia/fibrillation in abnormal J wave group is significantly higher than those of without abnormal J waves group during hospitalization ,but abnormal ECG J waves cannot pre‐dict short-term prognosis of these patients .%目的：探讨急性ST段抬高型心肌梗死（ASTEMI）患者心电图异常J波与住院期间预后的关系。方法：回顾性分析2007年1月至2012年12月在我院行急诊冠脉介入治疗（PCI）的204例ASTEMI患者心电图及相关临床资料，根据有无异常J波，分为异常J波组（82例，占40.2％，82／204）和无异常J波组（122例，占59.8％，122／204），应用单因素、多因素Logistic回归分析患者住院期间死亡的危险因素。结果：住院期间心电图异常J波组的持续性室速／室颤发生率，显著高于无异常J波者（9.8％比1.6％， P＝0.008 ），但12例心因性死亡患者中，仅6例存在异常J波。Logistic回归分析显示，心电图异常 J波并不能预测 ASTEMI患者住院期间死亡（OR＝0.99，95％ CI：0.34～2.90， P＝0.987），而年龄是此类患者住院期间死亡的的独立预测因子（OR＝1.08，95％ CI：1.01～1.15， P＝0.02）。结论：尽管急性S T段抬高型心肌梗死合并异常J波者住院期间持续性室速／室颤的发生率显著高于无J波者，但心电图异常J波并不能预测此类患者的短期预后。