急性前壁心肌梗死急诊冠状动脉介入术后T波早期倒置对预后的影响

摘要

目的:研究急性前壁心肌梗死急诊经皮冠状动脉介入(PCI)术后T波早期倒置对术后N末端B型钠尿肽前体(NT-pro BNP)、心功能和不良事件的影响.方法:连续入选急性前壁心肌梗死行急诊PCI治疗的患者162例.根据术后24h是否出现T波倒置分为两组:24h内T波倒置组96例,24h内T波未倒置组66例.所有患者监测心电图变化;术前、术后24h NT-pro BNP水平;术后24h及6个月时的超声心动图;6个月时主要不良心血管事件(MACE)的发生.结果:两组患者入院即刻的NT-pro BNP差异无统计学,但与T波未倒置组相比,T波倒置组术后24h的NT-pro BNP水平明显降低(P=0.002);两组患者术后24h的LVEDD、LVESD和LVEF无明显差异,但与T波未倒置组相比,T波倒置组6个月时LVEF较高(P=0.001),LVEDD及LVESD均较低(P分别为0.019和0.003).术后24h的NT-pro BNP水平与LVEF呈负相关,而术前NT-pro BNP水平与LVEF无相关性.术后6个月时T波倒置组的心力衰竭再住院及复合MACE的发生率较T波未倒置组低(P分别为0.029和0.003).结论:急性前壁心肌梗死急诊PCI术后T波早期倒置组术后24h的NT-pro BNP水平较低,术后6个月时的左心室大小和左心室功能恢复更好,且随访6个月时的预后更好.%Objective: To evaluate effects of early T wave inversion on NT-proBNP and cardiac function and adverse events after direct percutaneous coronary intervention (PCI) in patients with acute anterior myocardial infarction. Methods: One hundred and sixty-two consecutive patients with acute anterior wall myocardial infarction who underwent direct PCI therapy were selected. According to whether there was T wave inversion within 24 h after surgery, there were two groups: 96 cases of T wave inversion group within 24 h and 66 cases of T wave uninversion group. All patients were monitored for changes in electrocardiogram. At the same time, all patients were monitored preoperative and postoperative NT-proBNP levels at 24 h, echocardiography at 24 h and 6 months and the occurrence of MACE at 6 months. Results: There was no significant difference in NT-proBNP level before surgery between the two groups, However, compared with the t-wave uninverted group, the NTproBNP level in the early t-wave inverted group was significantly decreased at 24 after surgery (P = 0.002).There was no significant difference in LVEDD, LVESD and LVEF between the two groups at 24 hours after surgery, But, compared with the t-wave uninverted group, t-wave inverted group had higher LVEF (P = 0.001) and lower LVEDD and LVESD (P = 0.019 and 0.003, respectively) at 6 months. The NT-proBNP level at 24 h after surgery was negatively correlated with LVEF, while the NT-proBNP level before surgery was not correlated with LVEF. At 6 months after surgery, the incidence of re-hospitalization for heart failure and combined MACE in the T-wave inversion group was lower than that in the T-wave non-inversion group (P values were 0.029 and0.003, espectively). Conclusion: The NT-proBNP level at 24 h after surgery was lower in the early T wave inversion group after direct PCI in patients with acute anterior myocardial infarction, the left ventricular size and left ventricular function recovered better at 6 months after surgery, and the prognosis was better at 6 months of follow-up.