心电图T波形态对STEMI患者PCI治疗后近中期效果的影响

目的 探讨心电图T 波形态对STEMI 患者PCI 治疗后近中期效果的影响。方法 选取2016 年1 月～2017 年12 月于我院接受急诊PCI 救治的142 例STEMI 患者，根据PCI 术后24 h 的T 波形态分为T 波正常组（67 例）和T 波倒置组（75 例）。比较各组患者一般资料，PCI 术前、术后24 h 血清NT-proBNP 水平，PCI 术后24 h、1 个月心功能指标（LVEF、LVEDD、LVESD）及患者出院后1 年内主要不良心血管事件（MACE）发生情况。采用多因素Logistic 回归分析STEMI 患者出院1 年内发生MACE 的影响因素。结果 T 波倒置组前壁心肌梗死所占比例显著高于T 波正常组；PCI 术后24 h，血清NT-proBNP 水平显著低于T 波正常组；PCI 术后1 个月，LVEF 水平显著高于T 波正常组，LVEDD、LVESD 水平显著低于T 波正常组；出院后1 年内再发心肌梗死、因心血管事件再入院发生率及MACE 总发生率均显著低于T 波正常组，差异有统计学意义（P＜0.05）。多因素Logistic 回归分析结果显示，Killip 分级、前壁心肌梗死和心电图T 波形态是STEMI 患者出院1 年内发生MACE 的独立影响因素（P＜0.05）。结论 PCI 术后24 h 内心电图T 波倒置的STEMI 患者近中期左心室功能恢复较好，MACE 发生风险较低，对患者预后具有一定的预测价值。

Impacts of ECG T-wave on short and medium-term efficacy of STEMI patients after PCI treatment

Objective To explore the impacts of ECG T-wave on short and medium-term efficacy of ST-segment elevation myocardial infarction(STEMI) patients after PCI treatment.Methods A total of 142 STEMI patients who were given emergency PCI treatment and admitted to our hospital from January 2016 to December 2017 were selected and divided into the normal T-wave group(n=67) and the T-wave inversion group(n=75) according to the T-wave morphology 24 hours after PCI operation.The general information,the levels of serum NT-proBNP before and 24 hours after PCI operation,the indexes of cardiac function(LVEF,LVEDD,LVESD) at 24 hours and one month after PCI,and the occurrence of major adverse cardiovascular events(MACE) within one year after discharge were compared among the patients in each group.Multivariate logistic regression was applied to analyze the impacting factors of MACE in STEMI patients within one year after discharge.Results The proportion of anterior myocardial infarction in the T-wave inversion group was significantly higher than that in the normal T-wave group.24 hours after PCI operation,the level of serum NTproBNP in the T-wave inversion group was significantly lower than that of the normal T-wave group.One month after PCI operation,the LVEF level in the T-wave inversion group was significantly higher than that of the normal T-wave group,while the LVEDD and LVESD levels in the T-wave inversion group were significantly lower than those of the normal T-wave group.The incidence of relapsed myocardial infarction,readmission due to cardiovascular events and total MACE within one year after discharge in the T-wave inversion group were significantly lower than those in the normal T-wave group,and the differences were statistically significant(P<0.05).Multivariate logistic regression analysis showed that Killip grade,anterior myocardial infarction and ECG T-wave morphology were independent impacting factors of MACE in STEMI patients within one year after discharge(P<0.05).Conclusion The left ventricular function of STEMI patients with inverted ECG T-wave within 24 hours after PCI operation recovers well in the short and medium-term,and the risk of MACE is low,which has certain predictive value for the prognosis of patients.