急性ST段抬高型心肌梗死直接冠脉成形术ST段变化的临床价值

目的探讨急性ST段抬高型心肌梗死患者行直接冠脉成形术，术前和术后ST段变化对远期心血管事件的临床预测价值。方法对54例ST段抬高型心肌梗死患者行直接冠脉成形术，观察术前和术后1h心电图ST段变化，计算ST段回落指数。对所有患者随访12个月，观察12个月内心血管事件（猝死、心肌梗死、再狭窄、再次血管重建、慢性心衰）发生情况。对ST段回落指数和随访心血管事件行ROC分析，并通过COX比例风险模型多因素回归分析ST段回落指数对12个月终点事件的独立预测价值。结果在12个月的随访中，发生心源性死亡2例，再发心绞痛4例，慢性心衰7例。ST段回落指数临界点取63％时，对目标心脏事件预测的ROC曲线下面积0．843，灵敏度76．9％，特异度78．0％。COX比例风险模型多因素回归分析显示ST段回落指数对目标终点事件具有独立预测价值。结论急性ST段抬高型心肌梗死患者行直接PCI术，术前和术后ST段的变化即ST段回落指数对术后12个月预后具有独立预测价值。

Predictive value of changes of ST segment in patients with acute ST-segment elevation myocardial infarction after primary percutaneous coronary intervention

Objective To explore the predictive value of ST segment changes on long-term cardiovascular events in patients with acute ST-segment elevation myocardial infarction after primary percutaneous coronary intervention（PCI）. Methods 54 cases of ST-segment elevation myocardial infarction experienced primary percuta- neous coronary intervention were enrolled, pre-and postoperative ST-segment changes were observed and the ST- segment resolution index（STRI） was calculated. All patients were followed up 12 months. Cardiovascular events ineluding cardiovascular death, myocardial infarction, restenosis, target vessel revaseularization and CHF were observed. Results In the 12-month follow-up, 2 cases was cardiac death, 4 eases was recurrent angina and chronic heart failure was found in 7 eases. Critical point of 63% of STRI predicted the target cardiac events. Area under the ROC curve that could predict the cardiovascular events was 0.843, and the predictive sensitivity was 76.9%, specificity was 78.0%. COX proportional hazard model multivariate regression analysis showed that STRI on the target endpeint has independent predictive value. Conclusion In patients with acute ST-segment elevation myocardial infarction undergoing primary PCI, preoperative and postoperative ST segment changes show independent predictive value to the 12-month prognosis.