心电图异常J波对急性ST段抬高型心肌梗死短期预后的预测价值  

Predictive value of abnormal electrocardiographic J wave on in-hospital outcome in patients with acute ST-segment elevation myocardial infarction

作　　者：张雁[1] 吴弘[1] 蒋巍[2] 张天嵩[2] 黄少华[2] 郭瑛[2] 孙育民[2] 周贇[2] 徐志强[2] 陶文其[2] 俞帅[2] 连敏[2] 王骏[2] 

机构地区：[1]第二军医大学附属长海医院心内科,上海200433 [2]上海市静安区中心医院心内科,200040

出　　处：《国际心血管病杂志》2015年第3期190-193,共4页International Journal of Cardiovascular Disease

基　　金：中国医师协会阳光心血管研究基金(SCRFCMDA201225)

摘　　要：目的：探讨急性ST段抬高型心肌梗死（STEMI）患者心电图异常J波与短期临床预后的关系。方法：回顾性分析2007年1月至2012年12月在我院行急诊冠状动脉介入治疗（PCI）的204例急性STEMI患者心电图及相关临床资料,应用单因素、多因素Logistic回归分析预测患者住院期间死亡的危险因素。结果：204例患者中,心电图检获异常J波的患者约占40%,多分布于心电图下壁导联。心电图异常J波阳性患者住院期间持续性室性心动过速或心室颤动的发生率显著高于异常J波阴性患者（10%对2%,P=0.008）。在12例（6%）心因性死亡患者中,6例存在异常J波。Logistic回归分析显示,心电图存在异常J波并不能预测急性STEMI患者住院期间死亡（HR=0.99,95%CI：0.34-2.90,P=0.987）,而年龄则可作为此类患者短期预后的独立预测因子（HR=1.08,95%CI：1.01-1.15,P=0.02）。结论：在急性STEMI患者中,异常J波阳性患者住院期间持续性室性心动过速或心室颤动的发生率显著高于J波阴性的患者,但心电图异常J波并不能预测此类患者的短期预后。Objective：To evaluate the relationship between abnormal electrocardiographic（ECG）J wave and in-hospital outcome in patients with acute ST-segment elevation myocardial infarction（STEMI）. Methods：ECG recordings and clinical data of acute STEMI patients who received emergent percutaneous coronary intervention（PCI）in our hospital between January 2007 and December 2012 were reviewed.Univariate and multivariate Logistic regression analyses were performed on the factors contributing to in-hospital death. Results：Abnormal J waves were detected in about 40% of the 204 patients,most of which occurred in inferior leads.The incidence of sustained ventricular tachycardia or fibrillation was higher in patients with abnormal J wave than without abnormal J wave（10% vs.2%,P=0.008）.Twelve cardiac deaths occurred including 6 patients with abnormal J wave.Logistic regression analysis showed that age（OR=1.08,95% CI：1.01-1.15,P=0.02）rather than abnormal Jwave（OR=0.99,95% CI：0.34-2.90,P=0.987）could be used as a predicting factor of in-hospital death. Conclusion：Though the incidence of sustained ventricular tachycardia or fibrillation is higher in acute STEMI patients with abnormal J wave than without abnormal J wave during hospitalization,abnormal ECG J wave cannot predict in-hospital outcome of those patients.

关 键 词：急性心肌梗死 J波 心律失常 预后 

分 类 号：R542.22[医药卫生—心血管疾病]