冠状动脉内心电图ST段改变对冠心病患者PCI相关心肌损伤判断价值

摘要

目的：评价择期经皮冠状动脉介入治疗( Percutaneous Coronary Intervention,PCI)术中冠脉内心电图( Intra-coronary Electrocardiogram ,IC-ECG)ST 段变化对于 PCI 相关心肌损伤(梗死)(PCI-related Myocardial Injury/Infarction, PMI)的诊断价值。方法连续纳入65例择期 PCI 的稳定性或不稳定性心绞痛患者,测定术前基础水平及术后6、12、18和24h 的血清心肌钙蛋白T ( cTnT)水平,记录术中IC-ECG ST段变化。 cTnT≥0.1ng/mL为心肌损伤组(PMI组),cT-nT<0.1ng/mL为无PMI组,记录PCI术中、术后出现的胸痛,随访术后1至6个月的心脏事件。结果术前cTnT 正常者中24例(36.9%)表现为有意义的IC-ECGST段变化(变化组),41例(63.1%)未见有意义的变化(对照组)。 PCI手术后30例发生cTnT≥0.1ng/mL(PMI组)中,22例出现有意义的IC-ECG ST改变(ST 段改变≥0.1 mv(1mm))的有(91.7%),术后35例cTnT<0.1ng/mL(无PMI组)中,出现有意义的IC-ECG ST改变(ST 段改变≥0.1 mv(1mm))仅2例(5.71%),两组差异有统计学意义(=31.714,P<0.001)。 Logistic回归显示PCI术中IC-ECG ST改变是心肌损伤的独立预测因素[OR=70．314,95%CI(6．175,800．657),P=0．001]。结论 IC-ECGST段改变能同步监测PMI,具有早期,准确,敏感等特点,为判断PCI术中PMI经济,安全且有效的方法。%Objective To evaluate the diagnostic value of intracoronary electrocardiogram( IC-ECG) ST-segment change for percutaneous coronary intervention(PCI) related myocardial injury/infarction(PMI). Methods 65consecutive patients with stable or unstable angina scheduled for percutaneous coronary intervention were enrolled. Before intervention and 6, 12, 18 and 24 hours after intervention, serum cardiac troponin T( cTnT) levels were tested. And we recorded the IC-ECG ST-segment changes during interventions. The PMI group was defined as cTnT≥0. 1ng/mL after PCI. And the none-PMI group was defined as cTnT<0. 1ng/mL. The intraoperative and postoperative chest pain, cardiac events during 1 to 6-month postoperative follow-up were recor-ded. Results All 65 patients’ serum cTnT levels located in the normal range before interventions. Significant intraoperative IC-ECG ST-segment changes(ST-segment change≥0. 1mv) manifested in 24 patients(change group), and the other 41 patients did not show significant changes in IC-ECG ST-segment(control group). After PCI, PMI was detected in 30 patients, and 22(91. 7%) of them showed significant intraoperative ST-segment change. While among the other 35 patients whose serum cTnT <0. 1ng/ml, only 2 (5. 71%) cases of significant ST-segment change was detected during the PCI. Significant difference was demonstrated by the Chi-square test( =31. 714,P<0. 001). And Logistic regression analysis showed that intraoperative IC-ECG ST-segment change was an independent predictive factor for myocardial injury[OR=70. 314, 95%CI]6. 175,800. 657), P=0. 001]. Conclusion IC-ECG is an effective method for predicting PMI. And IC-ECG ST-segment change can simultaneously and accurately monitor PMI.