美托洛尔对急性冠脉综合征患者急诊经皮冠状动脉介入术后QRS-T转角改变及其临床意义

目的 探讨美托洛尔干预对于急性冠脉综合征(ACS)患者急诊经皮冠状动脉介入术(PCI)术后QRS-T转角改变及其临床意义.方法 连续性纳入120例ACS患者,行急诊PCI手术开通罪犯血管,术后分为美托洛尔组60例和常规治疗组60例.另选取60名年龄相符,非冠心病(CHD)志愿者作为对照组.观察术前和术后额面QRS-T夹角情况与术后1年主要不良心血管事件(MACE)发生率的相关性.结果 ACS患者PCI术前额面QRS-T夹角均明显高于对照组(F=3.565,P=0.01).在急诊PCI后第3天可见美托洛尔组ACS患者额面QRS-T夹角明显回落(75.5±11.6)°vs(52.1±17.4)°,P<0.05.美托洛尔治疗与ACS患者急诊PCI术后额面QRS-T夹角改变(r=0.755,P=0.002)成正相关,而与MACE发生率(r=-0.543,P=0.009)存在负相关.ACS患者急诊PCI术后使用早期加用美托洛尔治疗后可以使MACE发生风险降低25％(P=0.009)、△额面QRS-T夹角(每增加1°)使MACE风险降低9％(P=0.011),而Gensini评分(每增加1分)使MACE发生风险升高45％(P=0.005).结论 ACS患者PCI术后早期应用美托洛尔治疗可以促进额面QRS-T夹角水平回落.额面QRS-T夹角回落幅度与MACE的发生相关.

The influence of metoprolol on QRS-T angle in patients with ACS after PCI treatment

Objective To evaluate the influence of metoprolol on QRS-T angle in patients with acute coronary syndrome(ACS) after ercutaneous coronary intervention(PCI)treatment. Methods One hundred and twenty patients with ACS were enrolled in this study and divided into two group:metoprolol group (n=60) and normal treatment group(n=60),equally and randomly.The levels of QRS-T angle were measured and analyzed in two time points:before PCI and 3 days after PCI. Results ACS patients showed a higher levels of QRS-T angle compared with controls.Levels of QRS-T angle in metoprolol group showed a significant reduction on the third day after PCI treatment compared with those in normal treatment group.Correlation analysis showed that metoprolol treatment was positively associated with changes of QRS-T angle,while negatively related with MACE incidence rate.Logistic regression analysis showed that metoprolol administration could decreased 9% incidence rate of MACE. Conclusion Early metoprolol treatment may enhance the reduction of QRS-T angle in ACS patients following PCI.The range of QRS-T angle is associated with occurrence rate of MACE.