急诊冠状动脉成形术术后ST段回落与急性ST段抬高型心肌梗死患者心电图缺血分级之间的关系

目的探讨初始心电图缺血分级对已接受急诊经皮冠状动脉介入术的急性ST段抬高型心肌梗死患者ST段回落的影响。方法本研究纳入3年内在本中心诊断为急性ST段抬高型心肌梗死并且行冠状动脉成形术术的患者188名。患者按心电图表现分为两组:2级缺血组(GI 2,ST段抬高不伴有QRS终末部分扭曲)和3级缺血组(GI 3,在ST段≥2个相邻导联抬高伴有QRS终末部分扭曲),分析患者术后心电图ST段回落与心电图缺血分级之间的关系,观察终点为院内心血管事件(死亡,非致命性再次心肌梗死,心力衰竭和恶性心律失常)。结果 GI 3组患者在接受急诊冠状动脉成形术后体表心电图ST段回落不良的发生率高于GI 2。结论尽管已经接受急诊经皮冠状动脉介入治疗,GI3仍然是急性ST段抬高型心肌梗死患者ST段回落不良的独立预测因子。

Study of correlation between myocardial grade of ischemia and ST segment resolution after primary percutaneous coronary intervention

Objective Previous study indicated a correlation between myocardial grade of ischemia(GI) and the prognosis of acute ST segment elevation myocardial infarction(STEMI).The primary percutaneous coronary intervention(PPCI) is the best treatment strategy for STEMI.And ST segment resolution was considered as the most important evidence regarding thrombolysis.However,whether there is a correlation between the myocardial grade of ischemia at diagnosis and ST segment resolution after primary percutaneous coronary intervention remains elusive.Methods Altogether 188 patients with STEMI who received PPCI in our center from 2008 to 2011 were enrolled in this study.The patients were divided into two groups based on different GIs,grade 2(referring to ST segment elevation without terminal QRS distortion),and grade 3(referring to ST elevation with terminal QRS distortion).The end point of observation was cardiovascular events that included death,non-fatal myocardial infarction,heart failure,and malignant arrhythmia.Results Grade 3 of ischemia has a high occurrence of imperfect ST segment resolution when compared to grade 2 of ischemia.Conclusion Grade 3 of ischemia at diagnosis is a negative prognostic factor regardless of PCCI.