急性ST段抬高心肌梗死直接经皮冠状动脉介入后残余ST段抬高与预后的关系

摘要

Objective To evaluate the relationship between the residual ST-segment elevation and the prognosis in patients with ST-segment elevation myocardial infarction ( STEMI) and received early reperfusion therapy with primary PCI. Methods Two hundred and twenty five patients,aged 61. 3 ± 12.7 were recruided in this retrospective study, and of them 1S6 were male and 118 cases of patients had acute anterior infarction. According to the sum of residual ST-segment elevation ( sumSTE) post primary PCI, patients were divided into group A (sumSTE < 0.1 Mv, re = 64); group B(0.1 Mv≤sumSTE <0. 3 Mv, n=46), group C(0. 3 Mv≤sumSTE <0.7 rnV, n=54) and group D (sumSTE≥0. 7 Mv, n=61). The levels of left ventricular ejection fraction (LVEF) in hospital and incidence of major adverse cardiaovascular events, including rates death, MI, UA, HF, rehospitalization at 6 months among the groups were analyzed. Results Seventy patients had major adverse cardiovascular events in the follow-up period. There was no significant sifference betteen group A and group B in the levels of LVEF,but that of group A was higher than that of group C ( 57. 68 ± 6. 72% vs. 54. 33 ± 8. 50% , P = 0. 028) and group D (57. 68 ± 6. 72% us. 51.27 ±9. 20% ,P = 0.001). The level of LVEF of group B was higher than that of group C (57. 60 ±8.40% vs. 54. 33 ±8.50% ,P =0.048) and group D (57. 60 ±8.40% vs. 51. 27 ±9. 20% ,P = 0.001) which had lower LVEF level than group C (51. 27 ±9. 20% vs. 54. 33 ±8. 50% ,P =0. 048). There was no significant difference between group A and group B in the incidence of MACE . The incidence of MACE in group A was lower than that in group C (14.1% vs. 33. 3%, X2 = 6.164,P =0.012) and group D ( 14. 1% vs. 50. 5% , X2 = 19. 392,P =0.001). There was no significant difference between group B and group C in the incidence of MACE(26. 1% vs. 33.3% ,X2 =0.621 ,P =0. 285). The incidence of MACE in group B was significantly lower than that in group D (26. 1% vs. 50. 5% , X2 =6. 674, P =0. 008) which had higher incidence of MACE than group C (50. 5% vs. 33. 3% ,X2 =3. 582, P = 0. 044). Conclusion After primary PCI, higher sumSTE was related with lower in-hospital left ventricular ejection fraction and higher incidence of major adverse cardiovascular events at 6 months follow-up.%目的 探讨急性ST段抬高心肌梗死(STEMI)直接经皮冠脉介入(PCI)后心电图残余ST段抬高总和与预后的关系.方法 依据PCI后心电图残余ST段抬高总和(sumSTE)的程度将患者分为A组(sumSTE ＜0.1 mV)、B组(0.1 mV≤sumSTE＜0.3 mV)、C组(0.3 mV≤sumSTE＜0.7mV)和D组(≥0.7 mV),观察sumSTE与住院期间左室射血分数(LVEF)及6月内总的主要心血管事件(MACE,包括心绞痛、再发心肌梗死、因心血管事件再入院、心衰和死亡等)发生率的关系.结果 共有225例患者.男性156例,女性69例,年龄(61.3±12.7)岁.急性前壁梗死118例,非前壁心肌梗死107例.A组LVEF明显高于C组(57.68±6.72%比54.33±8.50%)和D组(57.68 ±6.72%比51.27±9.20%).B组LVEF高于C组(57.60±8.40%比54.33±8.50%)和D组(57.60±8.40%比51.27±9.20%).C组LVEF高于D组(54.33±8.50%比51.27±9.20%).A、B组两组患者随访MACE发生率差异无统计学意义.但A组MACE发生率低于c组(14.1%比33.3%,x2 =6.164,P=0.012)和D组(14.1%比50.5%,x2= 19.392,P=0.001).B组、c组两组患者随访MACE发生率差异无统计学意义(26.1%比33.3%,x2 =0.621,P=0.285).但B组MACE发生率低于D组(26.1%比50.5%,x2=6.674,P=0.008).c组MACE发生率显著低于D组(33.3%比50.5%,x2=3.582,P =0.044).结论 STEMI患者PCI术后残余ST段抬高与患者住院期间左室EF值、6个月内MACE发生率相关.