摘要
背景定量分析心电图QRS波群有利于预测急性ST段抬高型心肌梗死患者预后及筛查高危患者。目的探讨入院时胸导联Q波总振幅与R波总振幅比值(ΣQ/ΣR)对急性ST段抬高型前壁心肌梗死患者急诊经皮冠状动脉介入治疗(PCI)后短期预后的预测价值。方法选取2017年1月—2019年1月于江苏省苏北人民医院行急诊PCI的急性ST段抬高型前壁心肌梗死患者201例,根据入院时胸导联ΣQ/ΣR三分位数分为低ΣQ/ΣR组(n=67)、中ΣQ/ΣR组(n=67)和高ΣQ/ΣR组(n=67)。比较三组患者一般资料、实验室检查指标、PCI情况、左心室射血分数(LVEF)、心电图检查结果及住院期间主要不良心血管事件(MACE)发生情况;入院时胸导联Q波总振幅(ΣQ)、R波总振幅(ΣR)、ΣQ/ΣR与急性ST段抬高型前壁心肌梗死患者症状发作至入院时间(SODT)、肌酸激酶同工酶(CK-MB)、PCI后24 h LVEF及随访3个月LVEF的相关性分析采用Spearman秩相关分析;急性ST段抬高型前壁心肌梗死患者住院期间MACE的影响因素分析采用多因素Logistic回归分析;绘制ROC曲线以评价入院时胸导联ΣQ/ΣR对急性ST段抬高型前壁心肌梗死患者住院期间MACE的预测价值。结果 (1)三组患者年龄、高血压发生率、糖尿病发生率、吸烟率、丙氨酸氨基转移酶(ALT)、血肌酐、Na+及行血栓抽吸术、右冠状动脉狭窄率>70%、PCI后使用血管紧张素转换酶抑制剂(ACEI)、PCI后使用β-受体阻滞剂者所占比例比较,差异无统计学意义(P>0.05);三组患者男性比例、收缩压、心率、Killip分级≥3级者所占比例、SOTD、CK-MB、天冬氨酸氨基转移酶(AST)、K+、无复流发生率、回旋支狭窄率>70%者所占比例、PCI后24 h LVEF、随访3个月LVEF及入院时胸导联ΣQ、ΣR比较,差异有统计学意义(P<0.01)。(2)高ΣQ/ΣR组患者住院期间MACE发生率高于低ΣQ/ΣR组、中ΣQ/ΣR组(P<0.05)。(3)Spearman秩相关分析结果显示,入院时胸导联ΣQ、ΣQ/ΣR与急性ST段抬高型前壁心肌梗死患者SODT、CK-MB呈正相关,与PCI后24 h LVEF、随访3个月LVEF呈负相关(P<0.01);入院时胸导联ΣR与急性ST段抬高型前壁心肌梗死患者SODT、CK-MB呈负相关,与PCI后24 h LVEF、随访3个月LVEF呈正相关(P<0.01)。(4)多因素Logistic回归分析结果显示,入院时胸导联ΣQ/ΣR是急性ST段抬高型前壁心肌梗死患者住院期间MACE的独立影响因素〔OR=1.115,95%CI(1.057,1.252),P<0.05〕。(5)入院时胸导联ΣQ/ΣR预测急性ST段抬高型前壁心肌梗死患者住院期间MACE的曲线下面积(AUC)为0.789〔95%CI(0.721,0.858)〕,最佳截断值为3.655,灵敏度为0.661,特异度为0.841。结论入院时胸导联ΣQ/ΣR是急性ST段抬高型前壁心肌梗死患者急诊PCI后住院期间MACE的影响因素,且对患者住院期间MACE具有一定预测价值,可作为评估急性ST段抬高型前壁心肌梗死患者急诊PCI后短期预后的指标。
Background Quantitative analysis of electrocardiographic QRS complex is helpful to evaluate the prognosis and screen high-risk patients with acute ST-segment elevation myocardial infarction. Objective To investigate the predictive value of chest lead ΣQ/ΣR at admission on short-term prognosis after emergency PCI in patients with acute ST-segment elevation anterior wall myocardial infarction. Methods A total of 201 patients with acute ST-segment elevation anterior wall myocardial infarction were selected in Northern Jiangsu People’s Hospital from January 2017 to January 2019,all of them underwent emergency PCI and were divided into A group(with low ΣQ/ΣR,n=67),B group(with medium ΣQ/ΣR,n=67)and C group(with high ΣQ/ΣR,n=67)according to the tertiles of chest lead ΣQ/ΣR at admission. General information,laboratory examination results,PCI related indicators,LVEF,electrocardiographic examination results and incidence of MACE during hospitalization were compared in the three groups;Spearman rank correlation analysis was used to analyze the correlations of chest lead ΣQ,ΣR and ΣQ/ΣR at admission with symptom onset to admission time(SODT),CK-MB,LVEF 24 hours after PCI and 3 months after follow-up in patients with acute ST-segment elevation anterior wall myocardial infarction;multivariate Logistic regression analysis was performed to identify the influencing factors of MACE during hospitalization in patients with acute ST elevation anterior wall myocardial infarction;ROC curve was drawn to evaluate the predictive value of chest lead ΣQ/ΣR at admission on MACE during hospitalization in patients with acute ST-segment elevation anterior wall myocardial infarction. Results (1)There was no statistically significant difference in age,incidence of hypertension or diabetes,smoking rate,ALT,Scr,Na+,proportion of patients underwent thrombus aspiration,with stenosis rate of right coronary artery>70%,using ACEI or β-receptor inhibitors after PCI in the three groups(P>0.05);there was statistically significant difference in male proportion,SBP,heart rate,proportion of patients with Killip grade ≥ 3,SOTD,CK-MB,AST,K+,incidence of no-reflow phenomenon,proportion of patients with stenosis rate of circumflex branch>70%,LVEF 24 hours after PCI and 3 months after follow-up,chest lead ΣQ andΣR at admission in the three groups,respectively(P<0.01).(2)Incidence of MACE during hospitalization in C group was statistically significantly higher than that in groups A and B,respectively(P<0.05).(3)Spearman rank correlation analysis results showed that,chest lead ΣQ and ΣQ/ΣR at admission was positively correlated with SODT and CK-MB in patients with acute ST-segment elevation anterior wall myocardial infarction,respectively,but was negatively correlated with LVEF 24 hours after PCI and 3 months after follow-up,respectively(P<0.05);chest lead ΣR at admission was negatively correlated with SODT and CK-MB in patients with acute ST-segment elevation anterior wall myocardial infarction,respectively,but was positively correlated with LVEF 24 hours after PCI and 3 months after follow-up(P<0.05).(4)Multivariate Logistic regression analysis results showed that,chest lead ΣQ/ΣR at admission was one of independent influencing factors of MACE during hospitalization in patients with acute ST-segment elevation anterior wall myocardial infarction〔OR=1.115,95%CI(1.057,1.252),P<0.05〕.(5)AUC,the optimal cut-off value,sensitivity and specificity of chest lead ΣQ/ΣR at admission in predicting MACE during hospitalization in patients with acute ST-segment elevation anterior wall myocardial infarction was 0.789〔95%CI(0.721,0.858)〕,3.655,0.661 and 0.841,respectively. Conclusion Chest lead ΣQ/ΣR at admission is one of influencing factors of MACE during hospitalization in patients with acute ST-segment elevation anterior wall myocardial infarction who were treated by emergency PCI,which has certain predictive value on MACE during hospitalization and is expected to be a indicator of short-term prognosis after emergency PCI in patients with acute ST-segment elevation anterior wall myocardial infarction.
作者
仇杰
谢勇
李雨涵
徐超凡
QIU Jie;XIE Yong;LI Yuhan;XU Chaofan(Clinical Medical College of Yangzhou University,Yangzhou 225001,China;Northern Jiangsu People's Hospital,Yangzhou 225001,China)
出处
《实用心脑肺血管病杂志》
2020年第1期17-22,32,共6页
Practical Journal of Cardiac Cerebral Pneumal and Vascular Disease
