入院时胸导联Q波总振幅与R波总振幅比值对急性ST段抬高型前壁心肌梗死患者急诊经皮冠状动脉介入治疗后短期预后的预测价值研究  

Predictive Value of Chest Lead ΣQ/ΣR at Admission on Short-term Prognosis after Emergency PCI in Patients with Acute ST-segment Elevation Anterior Wall Myocardial Infarction

作　　者：仇杰 谢勇[2] 李雨涵 徐超凡[2] QIU Jie;XIE Yong;LI Yuhan;XU Chaofan(Clinical Medical College of Yangzhou University,Yangzhou 225001,China;Northern Jiangsu People's Hospital,Yangzhou 225001,China)

机构地区：[1]扬州大学临床医学院,江苏省扬州市225001 [2]江苏省苏北人民医院,江苏省扬州市225001

出　　处：《实用心脑肺血管病杂志》2020年第1期17-22,32,共6页Practical Journal of Cardiac Cerebral Pneumal and Vascular Disease

摘　　要：背景定量分析心电图QRS波群有利于预测急性ST段抬高型心肌梗死患者预后及筛查高危患者。目的探讨入院时胸导联Q波总振幅与R波总振幅比值(ΣQ/ΣR)对急性ST段抬高型前壁心肌梗死患者急诊经皮冠状动脉介入治疗(PCI)后短期预后的预测价值。方法选取2017年1月—2019年1月于江苏省苏北人民医院行急诊PCI的急性ST段抬高型前壁心肌梗死患者201例,根据入院时胸导联ΣQ/ΣR三分位数分为低ΣQ/ΣR组(n=67)、中ΣQ/ΣR组(n=67)和高ΣQ/ΣR组(n=67)。比较三组患者一般资料、实验室检查指标、PCI情况、左心室射血分数(LVEF)、心电图检查结果及住院期间主要不良心血管事件(MACE)发生情况;入院时胸导联Q波总振幅(ΣQ)、R波总振幅(ΣR)、ΣQ/ΣR与急性ST段抬高型前壁心肌梗死患者症状发作至入院时间(SODT)、肌酸激酶同工酶(CK-MB)、PCI后24 h LVEF及随访3个月LVEF的相关性分析采用Spearman秩相关分析;急性ST段抬高型前壁心肌梗死患者住院期间MACE的影响因素分析采用多因素Logistic回归分析;绘制ROC曲线以评价入院时胸导联ΣQ/ΣR对急性ST段抬高型前壁心肌梗死患者住院期间MACE的预测价值。结果 (1)三组患者年龄、高血压发生率、糖尿病发生率、吸烟率、丙氨酸氨基转移酶(ALT)、血肌酐、Na+及行血栓抽吸术、右冠状动脉狭窄率>70%、PCI后使用血管紧张素转换酶抑制剂(ACEI)、PCI后使用β-受体阻滞剂者所占比例比较,差异无统计学意义(P>0.05);三组患者男性比例、收缩压、心率、Killip分级≥3级者所占比例、SOTD、CK-MB、天冬氨酸氨基转移酶(AST)、K+、无复流发生率、回旋支狭窄率>70%者所占比例、PCI后24 h LVEF、随访3个月LVEF及入院时胸导联ΣQ、ΣR比较,差异有统计学意义(P<0.01)。(2)高ΣQ/ΣR组患者住院期间MACE发生率高于低ΣQ/ΣR组、中ΣQ/ΣR组(P<0.05)。(3)Spearman秩相关分析结果显示,入院时胸导联ΣQ、ΣQ/Background Quantitative analysis of electrocardiographic QRS complex is helpful to evaluate the prognosis and screen high-risk patients with acute ST-segment elevation myocardial infarction. Objective To investigate the predictive value of chest lead ΣQ/ΣR at admission on short-term prognosis after emergency PCI in patients with acute ST-segment elevation anterior wall myocardial infarction. Methods A total of 201 patients with acute ST-segment elevation anterior wall myocardial infarction were selected in Northern Jiangsu People’s Hospital from January 2017 to January 2019,all of them underwent emergency PCI and were divided into A group(with low ΣQ/ΣR,n=67),B group(with medium ΣQ/ΣR,n=67)and C group(with high ΣQ/ΣR,n=67)according to the tertiles of chest lead ΣQ/ΣR at admission. General information,laboratory examination results,PCI related indicators,LVEF,electrocardiographic examination results and incidence of MACE during hospitalization were compared in the three groups;Spearman rank correlation analysis was used to analyze the correlations of chest lead ΣQ,ΣR and ΣQ/ΣR at admission with symptom onset to admission time(SODT),CK-MB,LVEF 24 hours after PCI and 3 months after follow-up in patients with acute ST-segment elevation anterior wall myocardial infarction;multivariate Logistic regression analysis was performed to identify the influencing factors of MACE during hospitalization in patients with acute ST elevation anterior wall myocardial infarction;ROC curve was drawn to evaluate the predictive value of chest lead ΣQ/ΣR at admission on MACE during hospitalization in patients with acute ST-segment elevation anterior wall myocardial infarction. Results (1)There was no statistically significant difference in age,incidence of hypertension or diabetes,smoking rate,ALT,Scr,Na+,proportion of patients underwent thrombus aspiration,with stenosis rate of right coronary artery>70%,using ACEI or β-receptor inhibitors after PCI in the three groups(P>0.05);there was statistically significant differ

关 键 词：前壁心肌梗死 ST段抬高 Q波总振幅与R波总振幅比值 主要不良心血管事件 预后 预测价值 

分 类 号：R542.22[医药卫生—心血管疾病]