心电图特征在经皮冠状动脉介入治疗急性前壁心肌梗死患者中的预测价值  

Prognostic value of ECG characteristics in patients with acute anterior myocardial infarction treated with percutaneous coronary intervention

作　　者：高德全[1] 贾文芳[1] 谢亚闯 刘明涛[1] 董新博[1] 方雪花[1] 李晓涛[2] 

机构地区：[1]首都医科大学附属北京良乡医院心内科,北京102401 [2]武警北京总队医院心内科,北京100027

出　　处：《中国急救医学》2017年第5期439-442,共4页Chinese Journal of Critical Care Medicine

摘　　要：目的探讨影响经皮冠状动脉介入治疗（PCI）急性前壁心肌梗死患者预后的心电图（ECG）危险特征，并建立心电图风险评分预测模型。方法本研究纳入213例PCI术的急性前壁心肌梗死患者，根据患者出院时心电图特征，经Cox分析判断影响患者预后的危险因素，并据此建立心电图风险评分模型。结果213例患者中主要临床终点不良事件发生率为41例（19．25％），平均随访时间为（12．05±2．52）个月。Cox回归分析显示，室性期前收缩（P=0．004）、ORS间期≥110ms（P=0．002）、QT离散度≥80Iris（P=0．029）及碎裂Qas波（P=0．026）为预测本研究主要临床终点不良事件发生的心电图危险特征。根据患者心电图特征评分，将患者分为0～2分组和〉2分组，其中〉2分组患者主要临床终点不良事件发生明显高于0～2分组患者。结论PCI治疗急性前壁心肌梗死患者出院时心电图中室性期前收缩、QRS间期≥110ms、QT离散度≥80ms及碎裂QRS波为预测本研究主要临床终点不良事件发生的独立心电图危险特征。本研究所建立的心电图风险评分对患者的预后有一定的判断价值。Objective To investigate independent electrocardiogram （ECG） risk predictors for patients with acute anterior myocardial infarction treated with percutaneous coronary intervention and to establish its ECG prognostic model. Methods 213 patients with acute anterior myocardial infarction treated with percutaneous coronary intervention were included in this study. According to the ECG parameters of patients at discharge, COX regression models was performed to determine ECG risk predictors and a ECG risk score was established for these patients. Results The primary composite adverse clinical events occurred in 19.25% of the 213 patients, and the mean follow - up period was （ 12.05 ± 2.52） months. On Cox regression analysis, ventricular premature contraction （ P = 0. 004 ）, QRS duration ≥110 ms （P = 0. 002 ）, QT dispersion ≥ 80 ms （P = 0. 029 ） and fragmented QRS complex （P = 0. 026） were the risk predictors of the primary composite adverse clinical events in this study. Based on the ECG risk score, the patients were divided into 0 - 2 score group and 〉 2 score group. The incidence of the primary composite adverse clinical events was significantly higher in 〉 2 score group than that in 0 -2 score group. Conclusion ECG QRS duration ≥ 110 ms, QT dispersion≥80 ms, fragmented QRS complex and ventricular premature contraction at discharge are independent risk predictors in patients with acute anterior myocardial infarction treated with percutaneous coronary intervention in this study. ECG risk score established in this study shows a certain prognostic value.

关 键 词：急性前壁心肌梗死 经皮冠状动脉介入治疗(PCI) 心电图(ECG) 预后 

分 类 号：R654.2[医药卫生—外科学]