急性ST段抬高心肌梗死QRS波终末变形与直接PCI疗效关系的研究

目的探讨急性ST段抬高心肌梗死(STEMI)患者心电图QRS波终末变形对直接经皮冠脉介入治疗(PCI)疗效的影响。方法根据入院心电图将STEMI患者分成QRS波终末变形阳性(QRS+)组(n=23)与QRS终末变形阴性(QRS-)组(n=47),两组均行直接PCI治疗。测定肌酸激酶同工酶(CK-MB)峰值、心电图ST段抬高导联数、QRS记分及观察6个月内严重心血管不良事件,并于PCI术后2周与6个月时行超声心动图检查。结果(1)QRS+组与QRS-组CK-MB峰值〔(309.19±55.48)U/L与(285.17±31.92)U/L〕、ST段抬高导联数〔(4.06±0.54)与(3.76±0.44)〕、QRS记分〔(6.09±2.36)与(4.86±1.25)〕比较,差异有统计学意义(P<0.05)。(2)两组患者严重心血管不良事件比较差异无统计学意义(P>0.05)。(3)两组组内术后6个月与术后2周左心室舒张末期容积指数(LVEDVI)、左室收缩末期容积指数(LVESVI)、室壁活动异常积分(VWMA)及左室射血分数(LVEF)比较,差异均有统计学意义(P<0.05)。(4)术后6个月时QRS+组LVEDVI、LVESVI及VWMA明显大于QRS-组〔LVEDVI(74.94±4.33)与(70.86±5.09);LVESVI(37.84±2.76)与(35.81±3.04);VWMA(9.57±1.12)与(8.53±2.16)〕,而LVEF明显低于QRS-组〔LVEF(42.81±5.61)%与(48.12±5.80)%,P<0.05〕。结论急性心肌梗死心电图QRS终末变形可降低直接PCI疗效,可能与此类患者最终梗死面积大、左室重构明显而降低左室功能有关。

The Relationship between QRS Complex Terminal Part Deformation and the Effects of Percutaneous Coronary Intervention in Patients with Acute ST Segment Elevation Myocardial Infarction

Objective To investigate the relationship between QRS complex terminal part deformation and the effects of percutaneous coronary intervention(PCI) in patients with acute ST segment elevation myocardial infarction(STEMI).Methods Seventy patients with STEMI were divided into 2 groups according to their admission electrocardiogram:QRS+ group with QRS complex terminal part deformation(n=23) and QRS-group without such deformation(n=47).Both groups received direst PCI treatment.The peak value of CK-MB,the leads number with ST segment elevation,the QRS score,and the cardiovascular events within 6 months were observed.The echocardiogram parameters were recorded 2 weeks and 6 months after PCI,respectively.Results(1)there were significant differences between QRS+ group and QRS-group,in the peak value of CK-MB((309.19±55.48)U/L vs.(285.17±31.92)U/L),the leads number with ST segment elevation((4.06±0.54) vs.(3.76±0.44)),and the QRS score((6.09±2.36) vs.(4.86±1.25))(P<0.05).(2) But there was no significant difference between the two groups,in the severe cardiovascular events during 6 months(P>0.05).(3)In each group,there were significant differences in LVEVI,LVESVI,VWMA and LVEF between those 2 weeks after PCI and those 6 month after PCI(P<0.05,all).(4)At the 6 month after PCI,LVEDVI,LVESVI and VWMA in QRS+ group were obviously higher than those in QRS-group(LVEDVI(74.94±4.33) vs.(70.86±5.09);LVESVI(37.84±2.76) vs.(35.81±3.04);VWMA(9.57±1.12) vs.(8.53±2.16)),while LVEF in QRS+ was obviously lower than that in QRS-group(LVEF(42.81±5.61)% vs.(48.12±5.80)%),all above being with significant differences(P<0.05,all).Conclusion QRS complex terminal part deformation in patients with STEMI indicates a less effective PCI,which is ascribed to the large myocardial infarction area and left ventricular dysfunction caused by left ventricular remodeling.