心电图QRS积分及缺血分级对AMI患者溶栓后PCI 6个月内支架内再狭窄的预测价  

The predictive value of QRS score and ischemia grade on electrocardiogram for in-stent restenosis within 6 months after PCI post-thrombolysis in AMI patients

作　　者：沈琴[1] 李文瑶 郑剑武 SHEN Qin;LI Wenyao;ZHENG Jianwu(Department of Electrocardiogram,Hangzhou Hospital of Traditional Chinese Medicine,Hangzhou 310006,China;不详)

机构地区：[1]杭州市中医院特检科,310006 [2]杭州市中医院心内科,310006

出　　处：《心电与循环》2023年第5期467-471,共5页Journal of Electrocardiology and Circulation

摘　　要：目的探讨心电图QRS积分及缺血分级对急性心肌梗死(AMI)患者溶栓后经皮冠状动脉介入治疗(PCI)6个月内支架内再狭窄的预测价值。方法选取2018年9月至2020年9月在杭州市中医院行溶栓后PCI的121例AMI患者为研究对象,根据PCI术后6个月内是否发生支架内再狭窄分为再狭窄组20例,无再狭窄组101例。比较两组患者入院时、PCI术前(溶栓后)及PCI术后3 d心电图QRS积分、缺血分级以及左心功能和心肌损伤指标[包括左心室射血分数(LVEF)、心肌肌钙蛋白I(c TnI)、肌酸激酶同工酶(CK-MB)、脑钠肽(BNP)],并分析心电图QRS积分及缺血分级与左心功能及心肌损伤指标的相关性。采用ROC曲线分析心电图QRS积分、缺血分级以及两者联合对PCI术后支架内再狭窄的预测效能。结果再狭窄组与无再狭窄组患者入院时、PCI术前及PCI术后3 d心电图QRS积分、缺血分级以及左心功能和心肌损伤指标比较,差异均有统计学意义(均P<0.05);组内手术前后各时点比较,差异均有统计学意义(均P<0.05)。入院时、PCI术前及PCI术后3 d心电图QRS积分、缺血分级与LVEF均呈负相关(均P<0.05),与血清c TnI、CK-MB、BNP水平均呈正相关(均P<0.05)。入院时、PCI术前及PCI术后3 d心电图QRS积分、缺血等级以及两者联合预测PCI术后支架内再狭窄的AUC分别为0.822、0.838、0.845,0.701、0.706、0.715和0.865、0.901、0.929,其中两者联合的预测价值明显高于同一时点单独指标的预测价值(均P<0.05)。结论心电图QRS积分及缺血分级对AMI患者溶栓后PCI 6个月内支架内再狭窄具有较高的预测价值,特别是两者联合。Objective To explore the predictive value of QRS score and ischemia grade on electrocardiogram for in-stent restenosis within 6 months after percutaneous coronary intervention(PCI)post-thrombolysis in patients with acute myocardial infarction(AMI).Methods One hundred and twenty-one AMI patients who underwent PCI postthrombolysis at Hangzhou Hospital of Traditional Chinese Medicine from September 2018 to September 2020 were enrolled and divided into a restenosis group of 20 patients and a non-restenosis group of 101 patients based on whether in-stent restenosis occurred within 6 months after PCI.QRS score and ischemia grade,left heart function and myocardial injury indicators[including left ventricular ejection fraction(LVEF),cardiac troponin I(cTnI),creatine kinase isoenzyme(CK-MB),and brain natriuretic peptide(BNP)]before and 3 days after PCI were compared between the two groups.The correlation of QRS score and ischemia grade of ECG with left heart function and myocardial injury index was analyzed.The ROC curve was used to analyze the predictive efficacy of QRS score,ischemia grade,and the combination of the two indicators for in-stent restenosis after PCI.Results There were statistically significant difference in QRS score,ischemia grade,left ventricular function and myocardial injury biomarkers between the two groups at admission,before and 3 days after PCI(all P<0.05),and between different time points in each group(all P<0.05).QRS score and ischemia grade were negatively correlated with LVEF and positively correlated with serum cTnI,CK-MB,and BNP at admission,before and 3 days after PCI(all P<0.05).At admission,before PCI and 3 days after PCI,the AUC of ECG QRS score,ischemia grade and their combination to predict intrastent restenosis after PCI were 0.822,0.838,0.845,0.701,0.706,0.715 and 0.865,0.901,0.929,respectively.The prediction value of combination of two indexes was significantly higher than that of single index at the same time point(all P<0.05).Conclusion A combination of QRS score and ischemia grad

关 键 词：急性心肌梗死 QRS积分 缺血分级 经皮冠状动脉介入治疗 支架内再狭窄 

分 类 号：R542.22[医药卫生—心血管疾病]