肌钙蛋白Ⅰ结合心电图aVR导联ST段变化对非ST段抬高型急性冠状动脉综合征临床预后的评估  

Predictive value of positive troponin I and ST-segment deviation in lead aVR for the assessment of prognosis of patients with non-ST-segment elevation acute coronary syndrome

作　　者：耿涛[1] 李亚[1] 刘斯静[2] 张之灜 王炳勋[1] 张建刚[1] 戴士鹏[1] 刘永兴[1] 徐泽升[1] 

机构地区：[1]河北省沧州市中心医院心内二科,061001 [2]河北医科大学

出　　处：《中国介入心脏病学杂志》2010年第3期151-156,共6页Chinese Journal of Interventional Cardiology

摘　　要：目的结合实验室检测肌钙蛋白Ⅰ与心电图aVR导联ST段抬高情况,探讨二者在非ST段抬高型急性冠状动脉综合征患者的预后评估中的价值。方法入选非ST段抬高型急性冠状动脉综合征患者255例,采血检验肌钙蛋白Ⅰ,并详细测量心电图AVR导联ST段抬高情况,均行冠脉造影,根据具体情况分别行冠脉介入治疗、冠脉搭桥手术及药物保守治疗,随访6个月,观察终点为不良心血管事件,包括心肌梗死(包括再梗)、心血管死亡和血运重建。结果在随访的6个月内,肌钙蛋白Ⅰ值(OR=7.01,95%CI=1.22～12.63,P=0.02)和aVR导联ST段抬高值(OR=1.38,95%CI=1.084～1.751,P=0.009)是患者发生死亡和心肌梗死(包括再梗)的独立危险因素;同时,肌钙蛋白Ⅰ值(OR=1.249,95%CI=1.114～1.501,P<0.01)和aVR导联ST段抬高值(OR=2.03,95%CI=1.20～4.29,P=0.04)亦是患者不良心血管事件(包括死亡、心肌梗死及血运重建术)发生的独立危险因素。在NSTE-ACS患者中,肌钙蛋白Ⅰ的升高的同时aVR导联ST段抬高者,其左主干病变或三支冠状动脉血管病变发生,以及不良心血管事件(包括死亡、心肌梗死、再梗、血运重建)的发生均是最高的。结论在临床中结合肌钙蛋白Ⅰ和心电图aVR导联ST段变化,可以早期应用于非ST段抬高型急性冠状动脉综合征患者预后的判断。Objective To investigate the predictive value of positive troponin I and ST-segment elevation in lead aVR on early prognosis of patients with non-ST-segment elevation acute coronary syndrome.The study also evaluates troponin I and ST-segment Elevation in Lead aVR as the predictors of the risk for the combined end points of cardiac events.Methods Two hundred and twenty five patients with non-ST-segment elevation acute coronary syndrome were included in our study.Baseline levels of troponin I and ST-segment elevation in lead aVR were determined and their relation to the outcomes at 6-month follow-up was further studied.Observation end was the rates adverse cardiovascular events including myocardial （re） infarction,cardiovascular death and repeat vascularization.Results After a follow-up of 6 months,increased troponin I （odds ratio 7.01,95% confidence interval 1.22 to 12.63,P=0.02） and ST-segment elevation in lead aVR （odds ratio 1.38,95% confidence interval 1.084 to 1.751,P=0.009） were found to be the only independent predictors of death and myocardial （re）infarction.And increased troponin I （odds ratio 1.249,95% confidence interval 1.114 to 1.501,P0.01） and ST-segment elevation in lead aVR （odds ratio OR=2.03,95% confidence interval 1.20 to 4.29,P=0.04） were the only independent predictors of the adverse cardiovascular events including myocardial （re）infarction,cardiovascular death and revascularization.With increased troponin I and ST-segment elevation in lead aVR on admission,patients with non-ST-segment elevation acute coronary syndrome had higher prevalence of left main or 3-vessel coronary disease,and higher adverse event rates after 6 months.Conclusion Elevation of tropinin I combined with ST-segment elevation in lead aVR is an useful assessment for early risk verification in patients with non-ST-segment elevation acute coronary syndrome.

关 键 词：肌钙蛋白Ⅰ AVR导联ST段抬高 非ST段抬高型急性冠状动脉综合征 预后 

分 类 号：R541.4[医药卫生—心血管疾病]