|本期目录/Table of Contents|

[1]黄华敏.心电图QRS-T夹角与P波离散度对STEMI患者急诊PCI预后的评估价值[J].医学研究与战创伤救治(原医学研究生学报),2022,24(3):257-261.[doi:10.3969/j.issn.1672-271X.2022.03.007]
　HUANG Hua-min.Evaluation value of ECG QRS-T angle and P-wave dispersion on the prognosis of emergency PCI in patients with STEMI[J].JOURNAL OF MEDICALRESEARCH —COMBAT TRAUMA CARE,2022,24(3):257-261.[doi:10.3969/j.issn.1672-271X.2022.03.007]
点击复制

心电图QRS-T夹角与P波离散度对STEMI患者急诊PCI预后的评估价值()
分享到62.8K

《医学研究与战创伤救治》（原医学研究生学报）[ISSN:1672-271X/CN:32-1713/R]

卷:
第24卷
期数:
2022年3期
页码:
257-261
栏目:
临床研究
出版日期:
2022-06-30

文章信息/Info

Title:
Evaluation value of ECG QRS-T angle and P-wave dispersion on the prognosis of emergency PCI in patients with STEMI
作者:
黄华敏
作者单位：100017北京，解放军第三○五医院心血管内科(黄华敏)
Author(s):
HUANG Hua-min
(Internal Medicine-Cardiovascular Department, 305 Hospital of PLA,Beijing 100017, China)
关键词:
急性ST段抬高型心肌梗死; 经皮冠状动脉介入术; QRS-T夹角; P波离散度; 院内主要不良心血管事件
Keywords:
acute ST segment elevation myocardial infarction;  percutaneous coronary intervention;  QRS-T angle;  P-wave dispersion;  major adverse cardiovascular events in hospital
分类号:
R541.4
DOI:
10.3969/j.issn.1672-271X.2022.03.007
文献标志码:
A
摘要:
目的研究心电图QRS-T夹角与P波离散度对急性ST段抬高型心肌梗死（STEMI）患者急诊经皮冠状动脉介入术（PCI）预后的评估价值。方法选择2018年3月-2020年10月在解放军第三○五医院接受急诊PCI治疗的162例STEMI患者，评估PCI后院内主要不良心血管事件（MACE）并将入组患者分为MACE组（n=36）和非MACE组（n=126），比较2组间一般资料、入院时实验室指标及PCI后1 h内心电图QRS-T夹角、P波离散度的差异，在logistic回归模型中分析院内MACE的影响因素，采用ROC曲线分析不同指标对院内MACE的预测价值。结果MACE组的年龄[（65.38±11.82）岁 vs (61.03±8.38)岁]、多支病变比例（64.29% vs 41.04%）、入院时超敏CRP[16.27(9.11, 29.47)mg/L vs13.11(7.92, 24.58)mg/L]、磷酸肌酸激酶同工酶[（94.11±19.82）U/L vs (88.27±11.85)U/L]、心肌肌钙蛋白[（4.43±1.17）μg/dL vs (3.97±0.82)μg/dL]水平及PCI后QRS-T夹角[（88.11±15.33）° vs (71.24±14.17)°]、P波离散度[（48.50±11.90） vs (35.64±10.24)]高于非MACE组（P<0.05）；logistic回归分析显示，PCI后QRS-T夹角、P波离散度是院内MACE的影响因素（P<0.05）；ROC曲线分析显示，QRS-T夹角、P波离散度单独及联合指标均对院内MACE具有预测价值。结论PCI后心电图QRS-T夹角、P波离散度增加与STEMI患者急诊PCI后发生院内MACE有关，联合使用QRS-T夹角及P波离散度对院内MACE具有较好的预测价值。
Abstract:
ObjectiveTo study the value of ECGQRS-T angle and P-wave dispersion in evaluating the prognosis of emergency percutaneous coronary intervention (PCI) in patients with acute ST segment elevation myocardial infarction (STEMI).MethodsOne hundred and sixty-two STEMI patients who received emergency PCI in our hospital from March 2018 to October 2020 were selected. The main adverse cardiovascular events (MACE) in the hospital after PCI were evaluated and the enrolled patients were divided into MACE group (n=36) and non MACE group (n=126). The differences of general data, laboratory indexes at admission, ARS-T angle and P-wave dispersion of ECG 1 h after PCI were compared between the two groups. Logistic regression model was used to analyze the influencing factors of in-hospital MACE, and ROC curve was used to analyze the predictive value of different indexes on in-hospital MACE.ResultsThe age [(65.38±11.82) years old vs (61.03±8.38) years old], the proportion of multi vessel lesions (64.29% vs 41.04%), the levels of high-sensitivity CRP [16.27(9.11, 29.47)mg/L vs 13.11(7.92, 24.58)mg/L], phosphocreatine kinase isozyme [(94.11±19.82)U/L vs (88.27±11.85)U/L], cardiac troponin I [(4.43±1.17)μg/dL vs (3.97±0.82)μg/dL], QRS-T angle [(88.11±15.33)° vs (71.24±14.17)°] and P-wave dispersion [(48.50±11.90) vs (35.64±10.24)] after PCI of MACE group were higher than those of non MACE group (P<0.05). Logistic regression analysis showed that QRS-T angle and P wave dispersion were the influencing factors of in-hospital MACE after PCI (P<0.05). ROC curve analysis showed that QRS-T angle and P wave dispersion alone and combined index had predictive value for in-hospital MACE.ConclusionThe increase of QRS-T angle and P wave dispersion of ECG after PCI is associated with in-hospital MACE of STEMI patients after emergency PCI. The combined use of QRS-T angle and P wave dispersion has good predictive value for in-hospital MACE.

参考文献/References:

[1]Tibaut M, Mekis D, Petrovic D.Pathophysiology of Myocardial Infarction and Acute Management Strategies[J]. Cardiovasc Hematol Agents Med Chem, 2017, 14(3):150-159.
[2]Ge Z, Baber U, Claessen BE, et al. The prevalence, predictors and outcomes of guideline-directed medical therapy in patients with acute myocardial infarction undergoing PCI, an analysis from the PROMETHEUS registry[J]. Catheter Cardiovasc Interv, 2019, 93(3):E112-E119.
[3]陈步宽, 万镇, 刘品刚. STEMI患者急诊PCI术后出现短期不良心血管事件的因素分析[J]. 中国急救复苏与灾害医学杂志, 2021, 16(6): 605-608.
[4]迪丽努尔·买买提伊明, 都雯, 高嵩. 平面QRS-T夹角对急性心肌梗死PCI术后恶性室性心律失常的预测价值及其与预后的相关性分析[J]. 中国医学装备, 2018, 15(2): 70-73.
[5]张明亮, 张焕轶, 刘燕, 等. P波离散度与TIMI危险评分对STEMI患者新发房颤的预测价值[J]. 中华临床医师杂志（电子版）, 2016, 10(1): 1-5.
[6]中华医学会心血管病学分会，中华心血管病杂志编辑委员会. 急性ST段抬高型心肌梗死诊断和治疗指南[J]. 中华心血管病杂志, 2015, 43(5): 380-393.
[7]中华医学会心血管病学分会心力衰竭学组, 中国医师协会心力衰竭专业委员会, 中华心血管病杂志编辑委员会. 中国心力衰竭诊断和治疗指南2018[J]. 中华心血管病杂志, 2018, 46(10): 760-789.
[8]曹克将. 细化诊断、危险分层与治疗—室性心律失常中国专家共识解读[J]. 中国循环杂志, 2016, 31(z2): 86-89.
[9]中华医学会神经病学分会, 中华医学会神经病学分会脑血管病学组. 中国急性缺血性脑卒中诊治指南2014[J]. 中华神经科杂志, 2015, 48(4): 246-257.
[10]中华医学会神经病学分会, 中华医学会神经病学分会脑血管病学组. 中国脑出血诊治指南(2014)[J]. 中华神经科杂志, 2015, 48(6): 435-444.
[11]Kumar D, Patra S, Pande A,et al. Long-term clinical outcomes of thrombus aspiration in STEMI patients undergoing primary percutaneous coronary intervention[J]. Am J Cardiovasc Dis, 2020, 10(2):117-123.
[12]Wu JW, Hu H, Li D, et al. In-hospital outcomes of delayed stenting in hemodynamically stable patients with ST-segment elevation myocardial infarction: the CCC (Care for Cardiovascular Disease in China) project[J]. Cardiovasc Diagn Ther, 2019, 9(5):462-471.
[13]黄修献, 王圣, 李斌, 等. 老年冠心病患者介入术后院内心血管不良事件及其影响因素[J]. 中国老年学杂志, 2019, 39(16): 3867-3870.
[14]胡闽鑫, 宫剑滨. 急性ST段抬高型心肌梗死合并多支病变患者不同血运重建策略的比较[J]. 医学研究生学报, 2021, 34(4): 388-393.
[15]Xu L, Wang L, Li K, et al. Nicorandil prior to primary percutaneous coronary intervention improves clinical outcomes in patients with acute myocardial infarction: a meta-analysis of randomized controlled trials[J]. Drug Des Devel Ther, 2019, 29(13): 1389-1400.
[16]Li P, Ruan JW, Liu M, et al. Thrombus aspiration catheter improve the myocardial reperfusion of STEMI patients with high thrombus load during the emergency PCI operation[J]. J Cardiothorac Surg, 2019, 14(1):172.
[17]Ghonim AA, Mostafa A, Emara A, et al. Clinical outcome of intracoronary versus intravenous high-dose bolus administration of tirofiban in diabetic patients undergoing primary percutaneous coronary intervention[J]. Cardiovasc J Afr, 2019, 30(5):285-289.
[18]王国平, 蔡世文. 急性心肌梗死后心源性休克患者院内死亡情况分析及早期血运重建的影响[J]. 兰州大学学报（医学版）, 2020, 46(1): 53-57.
[19]Zhao X, Wang Y, Liu C,et al. Association between Variation of Troponin and Prognosis of Acute Myocardial Infarction before and after Primary Percutaneous Coronary Intervention[J]. J Interv Cardiol, 2020, 25(2020):4793178.
[20]Kuyumcu MS, zbay MB, zen Y, et al. Evaluation of frontal plane QRS-T angle in patients with slow coronary flow[J]. Scand Cardiovasc J, 2020, 54(1):20-25.
[21]Kurisu S, Nitta K, Sumimoto Y,et al. Effects of Myocardial Perfusion Defect on the Frontal QRS-T Angle in Anterior Versus Inferior Myocardial Infarction[J]. Intern Med, 2020, 59(1):23-28.
[22]Subramanian M, Ahamed H, Prabhu M,et al. The prognostic value of dispersion of repolarization in stress cardiomyopathy[J]. J Electrocardiol, 2020, 62:79-85.
[23]Sawant AC, Bhardwaj A, Srivatsa S,et al. Prognostic value of frontal QRS-T angle in predicting survival after primary percutaneous coronary revascularization/coronary artery bypass grafting for ST-elevation myocardial infarction[J]. Indian Heart J, 2019, 71(6):481-487.

相似文献/References:

[1]刘宇,曹清心,高玲.丹参川芎嗪注射液对急性ST段抬高型心肌梗死经皮冠状动脉介入术后患者的心肌保护作用机制[J].医学研究与战创伤救治(原医学研究生学报),2020,22(5):468.[doi:10.3969/j.issn.1672-271X.2020.05.004]
　LIU Yu,CAO Qing-xin,GAO Ling.Effect of Danshen Chuanxiong Injection on myocardial protection and its mechanism in patients with acute ST segment elevation myocardial infarction after PCI[J].JOURNAL OF MEDICALRESEARCH —COMBAT TRAUMA CARE,2020,22(3):468.[doi:10.3969/j.issn.1672-271X.2020.05.004]

备注/Memo

备注/Memo:
-
更新日期/Last Update: 2022-06-21