aVR导联ST段回落对非ST段抬高型急性冠脉综合征患者短期预后的评估价值

目的探讨aVR导联ST段抬高回落在非ST段抬高型急性冠脉综合征（NSTE-ACS）患者短期预后中的评估价值。方法纳入NSTE-ACS aVR导联抬高的患者45例;根据入院6h后aVR导联ST段是否回落分为ST段回落组（n=20）与非ST段回落组（n=25）;分析入选患者一般临床资料、心电图、冠状动脉造影结果,并对不良心脏事件的危险因素进行Logistic回归分析。结果 aVR导联ST段无回落组左主干＋三支血管病变率、30d内再发心肌梗死率、急诊PCI及冠脉旁路移植术比例均高于ST段回落组患者,具有统计学差异（P〈0.05）。Logistic回归分析显示,aVR导联ST段无回落是入院后30d内不良心脏事件（死亡、心肌梗死及行血运重建术）独立预测因子（OR=18.54,95%CI：3.57～96.1,P〈0.001）。结论 aVR导联ST段抬高无回落的NSTE-ACS患者其预后差于ST段抬高回落者,aVR导联ST段无回落是NSTE-ACS不良心血管事件的独立预测因子。

Appraisal value of ST-segment changes in lead aVR to short-term prognosis in patients with non-ST-elevation acute coronary syndrome

Objective To discuss the appraisal value of ST-segment changes in lead aVR to short-term prognosis in the patients with non-ST-elevation acute coronary syndrome(NSTE-ACS).Methods The patients with NSTE-ACS and lead aVR elevation(n=45) were selected and divided into ST-segment fall-back group(fall-back group,n=20) and non-ST-segment fall-back group(non-fall-back group,n=25) according to the changes of ST-segment in lead aVR in the patients after hospitalization for six hours.The general clinical materials and results of ECG and coronary angiography(CAG) were analyzed.The risk factors of major adverse cardiac events(MACE) were analyzed with Logistic regression.Results The morbidity of left main coronary artery and three-vessel disease,incidence of relapsed myocardial infarction within 30 days,and proportion of emergency PCI and coronary artery bypass grafting were higher in non-fall-back group than those in fall-back group(P<0.05).The analysis of Logistic regression showed that non-fall-back of ST-segment in lead aVR was an independent predictive factor to MACE(death,myocardial infarction and revascularization) in the patients within 30 days after hospitalization(OR=18.54,95%CI:3.57～96.1,P<0.001).Conclusion The prognosis is poorer in NSTE-ACS patients with ST-segment elevation and without ST-segment fall-back in lead aVR than that in NSTE-ACS patients with ST-segment elevation and fall-back.The non-fall-back of ST-segment in lead aVR is an independent predictive factor to MACE of NSTE-ACS.