急诊PCI术前fQRS与STEMI患者病情严重程度及术后主要心脏不良事件的关系
|
摘要
目的探究术前碎裂QRS波(fQRS)对急性ST段抬高型心肌梗死(STEMI)患者急诊经皮冠脉介入术(PCI)预后的预测价值。方法全部病例资料来源于2013年4月—2017年5月期间哈尔滨医科大学附属第二医院心电室接受心电图仪检查与急诊PCI术治疗的STEMI患者,共计100例,术前、术后2 h行常规12导联动态心电检测,根据术前心电图有无fQRS将患者分为fQRS组(42例)、nfQRS组(58例)。对比2组的临床资料、实验室指标及心电图指标,均至少随访1年,记录其主要心脏不良事件(MACE)发生情况,并以发生MACE为预后不良进行统计学分析。结果与nfQRS组相比,fQRS组患者肌钙蛋白(cTnI)峰值、肌酸激酶同工酶(CK-MB)峰值均明显升高,术前QRS间期明显延长,术后ST段抬高幅度明显增高,ST段回落率明显降低,差异均有统计学意义(P<0.05)。PCI术后1年随访期间fQRS组患者MACE发生率为40.48%,明显高于nfQRS组的13.79%,且fQRS组无MACE生存曲线低于nfQRS组,差异有统计学意义(P<0.05)。Cox风险回归分析显示术前QRS间期、术后ST段抬高幅度、术后ST段回落率及fQRS为预后不良的独立危险因素(P<0.05)。结论急诊PCI术前存在fQRS可能提示STEMI患者病情严重,其与术后MACE密切相关,可用于预测患者的预后情况。
Objective To investigate the value of preoperative fragmented QRS(fQRS) in prediction of the prognosis of patients with acute ST-segment elevation myocardial infarction(STEMI) undergoing emergency percutaneous coronary intervention(PCI). Methods A total of 100 patients with STEMI who underwent electrocardiogram(ECG) examination and emergency PCI in the hospital from April 2013 to May 2017 were enrolled in the study. Routine 12-lead dynamic ECG detection was performed before surgery and at 2 hours after surgery. According to the presence of fQRS on preoperative ECG, the patients were divided into fQRS group(42 cases) and nfQRS group(58 cases). The clinical data, laboratory parameters and ECG indicators were compared between the two groups. All patients were followed up for at least 1 year. The incidence of major adverse cardiac events(MACE) was recorded and statistical analysis was performed with occurrence of MACE as poor prognosis. Results Compared with the nfQRS group, the peaks of troponin(cTnI) and creatine kinase isoenzyme(CK-MB) were significantly higher in fQRS group. The preoperative QRS interval was significantly longer, the postoperative ST segment elevation was significantly greater, and ST segment drop rate was significantly lower(P<0.05). The incidence of MACE in fQRS group during 1-year follow-up after PCI was significantly higher than that in nfQRS group(40.48% vs. 13.79%), and the MACE free survival curve of fQRS group was lower than that of nfQRS group(P<0.05). Cox risk regression analysis showed that preoperative QRS interval, postoperative ST segment elevation, postoperative ST segment drop rate and fQRS were independent risk factors for poor prognosis(P<0.05). Conclusion The presence of fQRS before emergency PCI may indicate that patients with STEMI are seriously ill, which is closely related to postoperative MACE and can be used to predict the prognosis of patients.
Objective To investigate the value of preoperative fragmented QRS(fQRS) in prediction of the prognosis of patients with acute ST-segment elevation myocardial infarction(STEMI) undergoing emergency percutaneous coronary intervention(PCI). Methods A total of 100 patients with STEMI who underwent electrocardiogram(ECG) examination and emergency PCI in the hospital from April 2013 to May 2017 were enrolled in the study. Routine 12-lead dynamic ECG detection was performed before surgery and at 2 hours after surgery. According to the presence of fQRS on preoperative ECG, the patients were divided into fQRS group(42 cases) and nfQRS group(58 cases). The clinical data, laboratory parameters and ECG indicators were compared between the two groups. All patients were followed up for at least 1 year. The incidence of major adverse cardiac events(MACE) was recorded and statistical analysis was performed with occurrence of MACE as poor prognosis. Results Compared with the nfQRS group, the peaks of troponin(cTnI) and creatine kinase isoenzyme(CK-MB) were significantly higher in fQRS group. The preoperative QRS interval was significantly longer, the postoperative ST segment elevation was significantly greater, and ST segment drop rate was significantly lower(P<0.05). The incidence of MACE in fQRS group during 1-year follow-up after PCI was significantly higher than that in nfQRS group(40.48% vs. 13.79%), and the MACE free survival curve of fQRS group was lower than that of nfQRS group(P<0.05). Cox risk regression analysis showed that preoperative QRS interval, postoperative ST segment elevation, postoperative ST segment drop rate and fQRS were independent risk factors for poor prognosis(P<0.05). Conclusion The presence of fQRS before emergency PCI may indicate that patients with STEMI are seriously ill, which is closely related to postoperative MACE and can be used to predict the prognosis of patients.
引文
[1] DESCH S,STIERMAIER T,DE W S,et al.Thrombus Aspiration in Patients With ST-Segment Elevation Myocardial Infarction Presenting Late After Symptom Onset[J].JACC Cardiovasc Interv,2016,9(2):113-122.
[2] 陈功.冠状动脉慢性完全闭塞病变介入治疗的新进展[J].实用医院临床杂志,2017,14(3):161-166.
[3] 李冰晓,陈欣,胡伟国,等.碎裂QRS波对ST段抬高型急性心肌梗死1年期预后的预测价值[J].心脏杂志,2015,27(3):294-297.
[4] 刘彦民,李卫,常荣,等.碎裂QRS波与急性心肌梗死血管再通的研究[J].临床心电学杂志,2016,25(4):259-261.
[5] 中华医学会心血管病学分会.急性心肌梗死诊断和治疗指南[J].中华心血管病杂志,2001,29(12):710-725.
[6] 李国草,刘艳军,夏云龙,等.经皮冠状动脉介入术对急性心肌梗死碎裂QRS波的影响及预后分析[J].中国全科医学,2014,17(18):2083-2086.
[7] 林晓明,杨希立,赖玉琼,等.碎裂QRS波对急性ST段抬高型心肌梗死患者直接介入治疗后心肌灌注及预后的预测价值[J].广东医学,2017,38(12):1877-1879.
[8] SHAH M,MALUDUM O,BHALLA V,et al.QRS duration and left ventricular ejection fraction (LVEF) in non-ST segment elevation myocardial infarction (NSTEMI)[J].Int J Cardiol,2016,221(13):524.
[9] 韩晓慧,宋素华,吴哲兵.碎裂QRS波与急性心肌梗死患者预后的关系研究[J].实用心电学杂志,2015,24(2):341-344.
[10] 彭毅,陈晓玲,杨徐.碎裂QRS波群对老年非ST段抬高性心肌梗死患者临床诊断及冠状动脉病变程度的预测价值[J].中国急救医学,2018,38(2):133-137.
[11] 张凤梅,任国成,许长存,等.碎裂QRS波和缺血性J波与冠心病患者临床特征及预后的关系[J].山东医药,2016,56(12):51-53.
[12] 王学忠,王岳松,邵旭武,等.碎裂QRS波在急性心肌梗死经皮冠状动脉介入治疗术后再发主要心脏不良事件中的预后价值[J].中华急诊医学杂志,2014,23(7):746-751.
[13] 岑梅珠,刘凯东,鞠录艳.碎裂QRS波与急诊PCI患者左室射血分数的关系[J].中国医师杂志,2017,19(2):277-278.
[14] DUMAS F,BOUGOUIN W,GERI G,et al.Emergency PCI in Post-Cardiac Arrest Patients Without ST-Segment Elevation Pattern:Insights From the PROCAT II Registry[J].JACC Cardiovasc Interv,2016,9(10):1011-1018.
[15] 王锐,缪英,郝应禄,等.碎裂QRS波评价急性心梗患者预后的临床价值[J].临床心电学杂志,2015,24(5):338-341.
[16] 高德全,贾文芳,谢亚闯,等.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[J].中国急救医学,2017,37(5):439-442.
[2] 陈功.冠状动脉慢性完全闭塞病变介入治疗的新进展[J].实用医院临床杂志,2017,14(3):161-166.
[3] 李冰晓,陈欣,胡伟国,等.碎裂QRS波对ST段抬高型急性心肌梗死1年期预后的预测价值[J].心脏杂志,2015,27(3):294-297.
[4] 刘彦民,李卫,常荣,等.碎裂QRS波与急性心肌梗死血管再通的研究[J].临床心电学杂志,2016,25(4):259-261.
[5] 中华医学会心血管病学分会.急性心肌梗死诊断和治疗指南[J].中华心血管病杂志,2001,29(12):710-725.
[6] 李国草,刘艳军,夏云龙,等.经皮冠状动脉介入术对急性心肌梗死碎裂QRS波的影响及预后分析[J].中国全科医学,2014,17(18):2083-2086.
[7] 林晓明,杨希立,赖玉琼,等.碎裂QRS波对急性ST段抬高型心肌梗死患者直接介入治疗后心肌灌注及预后的预测价值[J].广东医学,2017,38(12):1877-1879.
[8] SHAH M,MALUDUM O,BHALLA V,et al.QRS duration and left ventricular ejection fraction (LVEF) in non-ST segment elevation myocardial infarction (NSTEMI)[J].Int J Cardiol,2016,221(13):524.
[9] 韩晓慧,宋素华,吴哲兵.碎裂QRS波与急性心肌梗死患者预后的关系研究[J].实用心电学杂志,2015,24(2):341-344.
[10] 彭毅,陈晓玲,杨徐.碎裂QRS波群对老年非ST段抬高性心肌梗死患者临床诊断及冠状动脉病变程度的预测价值[J].中国急救医学,2018,38(2):133-137.
[11] 张凤梅,任国成,许长存,等.碎裂QRS波和缺血性J波与冠心病患者临床特征及预后的关系[J].山东医药,2016,56(12):51-53.
[12] 王学忠,王岳松,邵旭武,等.碎裂QRS波在急性心肌梗死经皮冠状动脉介入治疗术后再发主要心脏不良事件中的预后价值[J].中华急诊医学杂志,2014,23(7):746-751.
[13] 岑梅珠,刘凯东,鞠录艳.碎裂QRS波与急诊PCI患者左室射血分数的关系[J].中国医师杂志,2017,19(2):277-278.
[14] DUMAS F,BOUGOUIN W,GERI G,et al.Emergency PCI in Post-Cardiac Arrest Patients Without ST-Segment Elevation Pattern:Insights From the PROCAT II Registry[J].JACC Cardiovasc Interv,2016,9(10):1011-1018.
[15] 王锐,缪英,郝应禄,等.碎裂QRS波评价急性心梗患者预后的临床价值[J].临床心电学杂志,2015,24(5):338-341.
[16] 高德全,贾文芳,谢亚闯,等.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[J].中国急救医学,2017,37(5):439-442.