女性急性心肌梗死静脉溶栓后ST段再抬高对预后的影响

目的 探讨女性急性心肌梗死（AMI）静脉溶栓成功后ST段延迟性再抬高对预后的影响。方法入选发病6h之内行溶栓治疗成功的女性AMI患者106例,根据溶栓12h后ST段是否再抬高分为ST段再抬高观察组（观察组,n=38）和ST段未再抬高对照组（对照组,n=68）。监测两组患者CK-MB峰值及峰值时间,溶栓后1周、2周、1月、3月、6月时复查心电图、动态心电图及心脏超声,6月内每月复查6min步行试验,比较两组上述指标差异。结果观察组年龄,合并高血压、糖尿病、高脂血症、肥胖者比例以及CK-MB峰值均显著高于对照组（P均〈0.05）,CK-MB峰值时间较对照组前移程度小（P〈0.05）,恶性心律失常、心力衰竭、室壁瘤发生率及死亡率均显著高于对照组（P〈0.05）,左室射血分数和6min步行实验值均低于对照组（P〈0.05）。结论女性急性心肌梗死溶栓成功后延迟性ST段再抬高者恶性心律失常、心力衰竭、室壁瘤、死亡发生率高,预后相对差。

Influence of delayed ST-segment re-elevation on prognosis after successful intravenous thrombolysis in female patients with acute myocardial infarction

Objective To investigate the influence of delayed ST-segment re-elevation on prognosis after successful intravenous thrombolysis in female patients with acute myocardial infarction(AMI).Methods The female AMI patients(n=106) with successful intravenous thrombolysis within 6 hours after disease onset were selected and divided into group of ST-segment re-elevation(re-elevation group,n=38) and group without ST-segment re-elevation(control group,n=68) according to whether there was ST-segment elevation 12 hours after successful intravenous thrombolysis.The peak value and peak time of creatine kinase-MB(CK-MB) were monitored in two groups.In one week,two weeks,one month,three months and six months after intravenous thrombolysis,the changes of ECG,dynamic ECG and echocardiography were re-examined.Within six months,6-minute walk test was reviewed every month.All the above indexes were compared between two groups.Results In re-elevation group,age,proportion of complicated hypertension,diabetes,hyperlipidemia and obesity,and peak value of CK-MB were all significantly higher than those in control group(all P<0.05).The degree of shift forward in peak time of CK-MB was lower in re-elevation group than that in control group(P<0.05).The incidence and mortality of malignant arrhythmia,heart failure and ventricular aneurysm were significantly higher in re-elevation group than those in control group(P<0.05).The values of left ventricular ejection fraction(LVEF) and 6-minute walk test were lower in re-elevation group than those in control group(P<0.05).Conclusion The incidence and mortality of malignant arrhythmia,heart failure and ventricular aneurysm are higher in female AMI patients with delayed ST-segment re-elevation after successful intravenous thrombolysis and the prognosis is poor.