非梗死相关动脉狭窄对急诊介入术后ST段抬高心肌梗死患者心室跨壁复极离散度的影响

目的探讨非梗死相关动脉(IRA)的不同程度病变对急诊PCI术后急性ST段抬高心肌梗死(STEMI)患者心室跨壁复极离散度(TDR)的影响。方法选择STEMI患者341例,经急诊PCI再通者212例(再通组),未能实现IRA再通者129例(非再通组)。再通组患者又根据IRA狭窄程度分为单支病变组(104例)和多支病变组(102例),除外6例狭窄等于50%患者。另选健康体检者36例(对照组)。以校正的T波顶点至终点时间(Tp-e/c,Tp-e/RR~(1/2))作为TDR的量化指标。比较术后不同时间单支病变组与多支病变组患者Tp-e/c降幅和降幅百分比。结果非再通组患者入院时Tp-e/c值明显大于对照组,差异有统计学意义(P<0.01)。与入院即刻比较,单支病变组患者术后Tp-e/c明显降低(P<0.01),且术后第3天较第2天明显下降(P<0.05);多支病变组患者术后Tp-e/c明显降低(P<0.01),术后3天内Tp-e/c无显著改变(P>0.05)。结论急诊PCI能有效降低STEMI患者发病早期的TDR,且改善效果与IRA的病变程度无关。

Influence of non-infarction-related artery stenosis on transmural dispersion of repolarization in STEMI patients after PCI

Objective To study the influence of different stenoses of non-infarction-related artery on transmural dispersion of repolarization(TDR) in ST elevated myocardial infarction(STEMI) patients after primary PCI.Methods 341 STEMI patients were divided into revascularized group(n=212) and unrevascularized group(n=129) according to whether successful reperfusion was accomplished after PCI.The patients in revascularized group were further divided into single-vessel group(104 cases) and multiple-vessel group(102 cases).Other 6 patients with moderate lesions(50%) were excluded.Thirty-six healthy persons without coronary heart disease were selected to serve as control group.Tp-e(in present study Tp-e was corrected and Tp-e/ RR~(1/2),Tp-e/c were adopted) was used as quantitation index of TDR.Decrease and decrease percentage of Tp-e/c were measured at different time points after operation and were compared between single vessel group and multiple-vessel group.Results Tp-e/c of patients in unrevascularized group was much higher in comparison with control group on admission(P<0.01).Tp-e/c of both single-vessel group and multiple-vessel group after operation was significantly reduced as compared with the values measured before operation(P'< 0.01).In single-vessel group,Tp-e/c was decreased on third day in comparison with the value measured on the second day(P<0.05). Conclusion Primary PCI can effectively reduce TDR in STEMI patients no matter how serious the stenosis is in non-infarction related artery.