急性ST段抬高型心肌梗死时Ⅲ级缺血的预测和预后价值

目的探讨行直接经皮冠状动脉介入治疗（PCI）的急性ST段抬高型心肌梗死（STEMI）患者Ⅲ级缺血的预测因素和预后价值。方法入选急诊PCI的STEMI患者312例,发病时间均在12 h以内,根据入院时心电图表现分为Ⅱ级缺血组（A组,n=198）和Ⅲ级缺血组（B组,n=114）,住院期间记录一般临床资料、TIMI危险评分、ST段回降率（STR）和院内死亡率。结果与A组相比,B组患者年龄较大、左心室射血分数（EF）值低、而TIMI危险评分〉3、Killip分级〉1和前壁心肌梗死的比例大（P〈0.05）;A组患者PCI术后STR〉50%较B组显著增加（53.54%和30.70%,P〈0.05）。2组院内死亡率分别为1.52%vs.6.14%,Logistic回归分析显示院内死亡率与Ⅲ级缺血呈正相关,有统计学意义（r=1.189,P〈0.05）。结论年龄大、低EF值、TIMI危险评分〉3、Killip分级〉1和前壁心肌梗死患者易出现入院时心电图Ⅲ级缺血,且Ⅲ级缺血对患者心肌灌注不良和院内死亡率有预测价值。

Predictors and outcome of grade 3 ischemia in patients with ST-segment elevation myocardial infarction

Objective To investigate the predictive factors and outcome of grade 3 ischemia in patients with ST-segment elevation myocardial infarction（STEMI） undergoing primary percutaneous coronary intervention （PCI）. Methods Patients with STEMI from the onset of symptoms to admission within 12 h were divided into two groups based on grade 2 ischemia（gruop A, n=198）or grade 3 ischemia（group B, n=114） in the admission electrocardiogram.Clinical data,TIMI risk score, ST-segment resolution（STR） and hospital motality were recorded in all patients. Results Patients with grade 3 ischemia were older, more TIMI risk score〉3（P=0.019）, Killip class〉1（P=0.041）, anterior myocardial infarction（P=0.010）, lower EF（P=0.001） and less complete STR. Hospital mortality was higher in patients with grade 3 ischemia compared with patients with grade 2 ischemia （1.52% and 6.14%, P=0.041）. Multivariable logistic regression analysis confirmed that hospital mortality was independently associated with grade 3 ischemia （OR：3.284, 95%CI：1.005 to 10.730, P=0.049）. Conclusion Grade 3 ischemia is associated with criteria （older age,TIMI risk score〉3, Killip class〉1, low ejection fraction and anterior myocardial infarction）, poor myocardial reperfusion and higher mortality rate in patients with STEMI.