心电图缺血分级与急诊PCI术后心血管事件  

The relationship between cardiovascular events and electrocardiographic ischemia grades in patients with acute ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention

作　　者：韩永生 汪庆童[2] 范西真 褚俊 余华 马礼坤 严激 严光 

机构地区：[1]安徽医科大学附属省立医院急救医学中心,230001 [2]安徽医科大学临床药理研究所,230032 [3]安徽医科大学附属省立医院心血管内科,230001

出　　处：《临床心电学杂志》2013年第3期179-182,共4页Journal of Clinical Electrocardiology

基　　金：国家自然科学基金青年基金项目(项目号:81202541)

摘　　要：目的心电图缺血分级(GI)已被证实可以预测急性ST段抬高型心肌梗死(STEMI)溶栓患者的预后,但尚不清楚心电图缺血分级对急诊经皮冠状动脉介入术(PPCI)的STEMI患者院内心血管事件的预测价值,本研究旨在探讨初始心电图缺血分级对已接受PPCI的STEMI患者住院期间心血管事件的影响。方法本研究纳入2008年7月至2011年8月在本中心诊断为STEMI并且接受PPCI的患者188例。患者按心电图表现分为两组:2级缺血组(GI2,ST段抬高不伴有QRS终末部分扭曲)和3级缺血组(GI3,在ST段≥2个相邻导联抬高伴有QRS终末部分扭曲)。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 GI3组患者心律失常发生率、心力衰竭或者心源性休克等心血管事件的发生率均高于GI2组,差异有统计学意义。结论尽管已经接受急诊经皮冠状动脉介入治疗,初始心电图3级缺血仍然是STEMI患者住院期间心血管事件的独立预测因子。Objective To analyze the relationship between Grade of ischemia（GI）and the prognosis of patients undergoing primary percutaneous coronary intervention（PPCI）.Methods Data for 188 patients undergoing PPCI enrolled in our study were obtained from one cardiac center.Patients were classified as having grade 2 ischemia（GI 2;ST segment elevation without terminal QRS distortion）or grade 3 ischemia（GI 3;ST segment elevation with terminal QRS distortion in 2 adjacent leads）.Outcomes were cardiovascular events（death,nonfatal repeat myocardial infarction,heart failure and malignant arrhythmia）.Results Cardiovascular events were significantly higher for GI 3 than for GI 2.After baseline adjustment,GI 3 was also associated with a higher incidence of cardiovascular events.Conclusion In STEMI patients,GI 3 is an independent predictor of cardiovascular events.

关 键 词：心电图缺血分级 急性ST段抬高型心肌梗死 急诊冠状动脉介入术 心血管事件 

分 类 号：R540.41[医药卫生—心血管疾病]