入院心电图无缺血改变的非ST段抬高型心肌梗死患者预后分析  

Prognosis analysis of patients with non-ST-segment elevation myocardial infarction without electrocardiogram on admission ECG

作　　者：刘学庆[1] 芮立美[1] 朱红涛[1] 丁晓军[1] 赵剑峰[1] 欧阳巍立 龚军辉[1] 张友明[1] Liu Xueqing;Rui Limei;Zhu Hongtao;Ding Xiaojun;Zhao Jianfeng;Ouyang Weili;Gong Junhui;Zhang Youming(Department of Cardiology,The People's Hospital of Danyang,Jiangsu 212300,China)

机构地区：[1]江苏省丹阳市人民医院心内科

出　　处：《中国循证心血管医学杂志》2019年第11期1342-1344,1348,共4页Chinese Journal of Evidence-Based Cardiovascular Medicine

基　　金：江苏省镇江市卫生科技重点专项项目(SHW2015020)

摘　　要：目的探讨非ST段抬高型急性心肌梗死(NSTEMI)患者入院心电图无缺血改变的发生率及其对预后的影响。方法回顾性分析2014年1月至2017年12月于丹阳市人民医院心内科住院的192例NSTEMI患者,根据急诊室12或18导联心电图表现,分为两组,即无缺血改变组及ST段压低组。了解NSTEMI患者心电图无缺血改变的发生率,住院期间及出院30 d心血管复合终点事件发生率。结果和ST段压低组相比,无缺血改变组多年纪轻,有近期吸烟史,心血管危险因素少。无缺血性改变组(n=110,57.3%)明显高于ST段压低组(n=82,42.7%)。无缺血改变组3支血管病变发生率低于ST段压低组(28.2%vs.41.5%,P=0.003),左主干(7.3%vs.24.4%,P=0.000)及前降支近端病变发生率(30.9%vs.41.5%,P=0.027)低于ST段压低组,无缺血改变组D-to-B时间(h)明显高于ST段压低组[(30.88±18.29)vs.(14.61±6.25),P=0.000]。住院期间MACE低于ST段压低组,但是30 d MACE两者无明显差别。结论根据入院心电图检查的结果,NSTEMI患者心电图无缺血改变发生率高、短期预后较ST段压低组好,但仍需要引起高度关注,及时实现再灌注治疗可能会改善预后。Objective To investigate the incidence of non-ischemic changes in patients with non-STsegment elevation acute myocardial infarction(NSTEMI)and its impact on prognosis.Methods From January 2014 to December 2017,192 patients with NSTEMI who were admitted to the Department of Cardiology of Danyang People's Hospital were divided into no ischemia group and ST group depression group according to the 12 or 18 lead electrocardiogram in the emergency department.The incidence of non-ischemic changes in the electrocardiogram of patients with NSTEMI,the incidence of cardiovascular composite endpoints during hospitalization and 30 days of discharge were recorded.Results Compared with the ST-segment depression group,the non-ischemic change group was lighter in age,had a recent history of smoking,and had fewer cardiovascular risk factors.There was no ischemic change group(n=110,57.3%),and the incidence was significantly higher than that of the ST segment depression group(n=82,42.7%).The incidence of 3-vessel disease in the non-ischemic change group was lower than that in the STsegment depression group(28.2%vs.41.5%,P=0.003),left main(7.3%vs.24.4%,P=0.000)and proximal anterior descending The incidence of lesions(30.9%vs.41.5%,P=0.027)was lower than that in the ST-segment depression group,and the D-to-B time(h)in the no-ischemia group was significantly higher than that in the ST-segment depression group((30.88±18.29)vs.(14.61±6.25),P=0.000).The MACE during hospitalization was lower than the ST-segment depression group,but there was no significant difference between the 30-day MACE.Conclusion According to the results of ECG examination,the incidence of ischemia-free electrocardiogram in patients with NSTEMI is high,and the short-term prognosis is better than that in the ST-segment depression group.However,it still needs to be highly concerned,and timely reperfusion therapy may improve the prognosis.

关 键 词：非ST段抬高型心肌梗死 心电图 心源性死亡 非致死性心肌梗死 靶血管重建 

分 类 号：R542.22[医药卫生—心血管疾病]