急性前壁ST段抬高型心肌梗死患者经皮冠状动脉介入治疗后病理性Q波消失对临床预后的影响  

Influence of pathological Q wave regression on clinical prognosis in the patients with anterior wall STEMI after percutaneous coronary intervention

作　　者：单红英 杨学东[2] 徐勇[2] 王至军 林剑 王禹 Shan Hong-ying;Yang Xue-dong;Xu Yong;Wang Zhi-jun;Lin Jian;Wang Yu(Medical Examination Center,Qinhuangdao Zhuozhong Hospital,Qinhuangdao 066000,China)

机构地区：[1]秦皇岛卓众医院体检中心,河北秦皇岛066000 [2]解放军总医院心内科,北京100853 [3]华北理工大学附属医院心内科,河北唐山063000 [4]秦皇岛市第一医院心内科,河北秦皇岛 [5]秦皇岛卓众医院心内科,河北秦皇岛066000

出　　处：《中国急救医学》2021年第8期718-724,共7页Chinese Journal of Critical Care Medicine

摘　　要：目的评价经皮冠状动脉介入术(PCI)治疗的急性前壁ST段抬高型心肌梗死(STEMI)患者病理性Q波变化对1年临床预后的影响。方法纳入2015年11月至2019年10月在秦皇岛市第一医院心内科行PCI治疗的急性前壁STEMI患者857例。根据患者心电图检查发现的病理性Q波情况,将患者分为无病理性Q波组(NQ组,n=76)、病理性Q波消失组(RQ组,n=416)与病理性Q波持续组(PQ组,n=365),收集三组的临床资料及肌酸激酶(CK)峰值,比较三组患者基线、随访1年超声心动图指标及预后不良情况。采用Cox风险比例模型,评价患者发生预后不良的独立相关因素。结果在纳入的857例患者中,有781例(91.1%)发生病理性Q波,其中有416例(53.3%)患者随访1年中病理性Q波消失,76例(8.7%)未发生病理性Q波。PQ组患者CK峰值较RQ组(t=6.772,P <0.001)与NQ组(t=14.002,P <0.001)明显提高,提示PQ组患者梗死面积较RQ组、NQ组明显提高。PQ组患者左心室(LV)重构较NQ组(t=23.145,P <0.001)与RQ组(t=14.090,P <0.001)明显提高。随访1年后,PQ组有26例(7.1%)死亡,RQ组有17例(4.1%)死亡,NQ组无患者死亡。多变量Cox风险比例模型分析表明,持续病理性Q波是急性前壁STEMI患者预后不良的独立相关因素(HR=1.283,95%CI 1.074~1.738,P=0.025)。结论急性前壁STEMI患者PCI治疗后,持续病理性Q波与心力衰竭或死亡风险增加独立相关,而病理性Q波消失患者预后不良率明显降低。Objective To evaluate the influence of pathological Q wave on 1-year clinical prognosis in the patients with anterior wall ST segment elevation myocardial infarction( STEMI) treated by percutaneous coronary intervention( PCI). Methods 857 STEMI patients who underwent PCI in the First Hospital of Qinhuangdao City from November 2015 to October 2019 were included. According to the pathological Q wave found by ECG examination,the patients were divided into non pathological Q wave group( NQ group,n = 76),pathological Q wave regression group( RQ group,n = 416) and pathological Q wave persistence group( PQ group,n = 365). The clinical data and creatine kinase( CK) peak value of the three groups were collected and compared. The baseline and one-year follow-up echocardiographic indexes and poor prognosis of the three groups were compared. Cox proportional hazard model was used to analyze the independent factors associated with poor prognosis. Results Among the 857 patients,781( 91. 1%) patients had pathological Q wave,416( 53. 3%) patients had pathological Q wave regression during one-year follow-up,and 76( 8. 7%) patients had no pathological Q wave. The peak value of CK in PQ group was significantly higher than that in RQ group( t = 6. 772,P < 0. 001)and NQ group( t = 14. 002,P < 0. 001),which suggested that the infarct size in PQ group was significantly larger than that in RQ group and NQ group. Left ventricular remodeling in PQ group was significantly higher than that in NQ group( t = 23. 145,P < 0. 001) and RQ group( t = 14. 090,P <0. 001). After one-year follow-up,26( 7. 1%) patients died in PQ group,17( 4. 1%) patients died in RQ group,and no patients died in NQ group. Multivariate Cox proportional hazard model analysis showed that persistent pathological Q wave was an independent prognostic factor for poor prognosis( HR = 1. 283,95% CI 1. 074-1. 738,P = 0. 025). Conclusions In the patients with anterior wall STEMI,persistent Q-wave after reperfusion is independently associated with the increased risk of heart failu

关 键 词：ST段抬高型心肌梗死(STEMI) 经皮冠状动脉介入术(PCI) 肌酸激酶(CK) 病理性Q波 预后 前壁 

分 类 号：R542.22[医药卫生—心血管疾病]