心电图缺血分级与急性心肌梗死靶血管定位及狭窄程度的关系
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摘要
目的探讨心电图缺血分级与急性心肌梗死(AMI)靶血管定位及狭窄程度的关系。方法共纳入80例AMI患者,发病时间<12 h,根据Birnbaum心电图缺血分级分为二级缺血组(50例)和三级缺血组(30例),采用冠脉CAG直径目视法比较靶血管定位及狭窄程度,CK-MB、cTnI和BNP水平,左室舒张末内径(LVEDd)和射血分数(LVEF);随访6个月,比较主要心脏不良事件(MACE)的发生率。结果三级缺血组CK-MB、cTnI和BNP的基线水平及升高幅度均大于二级缺血组,差异有统计学意义(P<0.05)。组间LVEDd和LVEF值比较无统计学差异(P>0.05)。三级缺血组左前降支、左主干和左主干分叉病变发生率较高,二级缺血组以回旋支和右冠及分支病变为主;三级缺血组平均靶病变数目和管腔狭窄程度显著高于二级缺血组,差异有统计学意义(P<0.05)。三级缺血组MACE发生率上升,差异有统计学意义(P<0.05)。结论心电图缺血分级可评估AMI靶血管定位及狭窄程度,有重要的临床应用价值。
Objective To explore the relationships between electrocardiogram ischemic classification and target vessel location and stenosis degree of acute myocardial infarction( AMI). Methods A total of 80 AMI patients with an onset time of less than 12 h were divided into the grade 2 ischemic group( n = 50) and the grade 3 ischemic group( n = 30) according to Birnbaum electrocardiogram ischemic classification. The target vessel localization and stenosis degrees were determined with CAG diameter visual method. Levels of CK-MB,cTnI and BNP,left ventricular end diastolic diameter( LVEDd) and ejection fraction( LVEF)were compared. The incidence of major adverse cardiac events( MACEs) after 6 months of follow-up was recorded. Results The baseline level and elevation of CK-MB,cTnI and BNP in the grade 3 ischemia group were greater than those in the grade 2 ischemia group,and the difference was statistically significant( P<0.05),but LVEDd and LVEF values in the two groups were not significantly different( P>0.05). The rates of lesions in the left anterior descending branch,left main coronary artery and left main coronary artery bifurcation in the grade 3 ischemia group were higher. The grade 2 ischemia group was dominated by lesions in the circumflex branch,the right coronary artery and the branches. The average number of target lesions and the degree of stenosis of the lumen in the grade 3 ischemia group were significantly larger or higher than those in the grade 2 ischemia group,and the difference was statistically significant( P<0.05). The incidence of MACEs in the grade 3 ischemic group increased,and the difference was statistically significant( P<0.05).Conclusion The electrocardiogram ischemic classification can evaluate the target vessel location and stenosis of AMI patients,and it is of important clinical value.
Objective To explore the relationships between electrocardiogram ischemic classification and target vessel location and stenosis degree of acute myocardial infarction( AMI). Methods A total of 80 AMI patients with an onset time of less than 12 h were divided into the grade 2 ischemic group( n = 50) and the grade 3 ischemic group( n = 30) according to Birnbaum electrocardiogram ischemic classification. The target vessel localization and stenosis degrees were determined with CAG diameter visual method. Levels of CK-MB,cTnI and BNP,left ventricular end diastolic diameter( LVEDd) and ejection fraction( LVEF)were compared. The incidence of major adverse cardiac events( MACEs) after 6 months of follow-up was recorded. Results The baseline level and elevation of CK-MB,cTnI and BNP in the grade 3 ischemia group were greater than those in the grade 2 ischemia group,and the difference was statistically significant( P<0.05),but LVEDd and LVEF values in the two groups were not significantly different( P>0.05). The rates of lesions in the left anterior descending branch,left main coronary artery and left main coronary artery bifurcation in the grade 3 ischemia group were higher. The grade 2 ischemia group was dominated by lesions in the circumflex branch,the right coronary artery and the branches. The average number of target lesions and the degree of stenosis of the lumen in the grade 3 ischemia group were significantly larger or higher than those in the grade 2 ischemia group,and the difference was statistically significant( P<0.05). The incidence of MACEs in the grade 3 ischemic group increased,and the difference was statistically significant( P<0.05).Conclusion The electrocardiogram ischemic classification can evaluate the target vessel location and stenosis of AMI patients,and it is of important clinical value.
引文
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[6]韩永生,汪庆童,范西真,等.心电图缺血分级与急诊PCI术后心血管事件[J].临床心电学杂志,2013,22(3):179.
[7]林文华,邸成业.不典型急性心肌梗死心电图原因分析[J].中国心脏起搏与心电生理杂志,2014,28(2):141.
[8]李慧.急性心肌梗死心电图改变与冠脉造影结果相关性分析[J].中西医结合心血管病电子杂志,2016,4(26):17.
[9]POSTMA S,HEESTERMANS T,TEN BERG JW,et al.Predictors andoutcome of grade 3 ischemia in patients with ST-segment elevationmyocardial infarction undergoing primary percutaneous coronary intervention[J].J Electrocardiol,2011,44(12):516.
[10]魏晓.急性ST抬高心肌梗死心电图心肌缺血分级的临床研究[J].现代诊断与治疗,2014,25(5):1108.
[11]林晓明,杨希立,刘鹤龄,等.缺血分级在急性ST段抬高型心肌梗死的临床价值[J].岭南心血管病杂志,2016,22(1):30.
[2]WEAVER J C,REES D,PRASAN A M,et al.Grade 3 ischemia on the admission electrocardiogram is associated with severe microvascular injury on cardiac magnetic resonance imaging after ST elevation myocardial infarction[J].J Electrocardiol,2011,44(1):49.
[3]张晓雷,王荣英,田英平,等.急性ST抬高心肌梗死心电图心肌缺血分级的临床意义[J].临床荟萃,2012,27(12):1018.
[4]韩永生,褚俊,杨杨,等.急诊冠状动脉成形术术后ST段回落与急性ST段抬高型心肌梗死患者心电图缺血分级之间的关系[J].安徽医学,2012,33(9):1149.
[5]梁芳,沈春莲,张伟,等.心电图碎裂QRS波在急性心肌梗死诊断中的价值[J].中国循环杂志,2011,26(5):363.
[6]韩永生,汪庆童,范西真,等.心电图缺血分级与急诊PCI术后心血管事件[J].临床心电学杂志,2013,22(3):179.
[7]林文华,邸成业.不典型急性心肌梗死心电图原因分析[J].中国心脏起搏与心电生理杂志,2014,28(2):141.
[8]李慧.急性心肌梗死心电图改变与冠脉造影结果相关性分析[J].中西医结合心血管病电子杂志,2016,4(26):17.
[9]POSTMA S,HEESTERMANS T,TEN BERG JW,et al.Predictors andoutcome of grade 3 ischemia in patients with ST-segment elevationmyocardial infarction undergoing primary percutaneous coronary intervention[J].J Electrocardiol,2011,44(12):516.
[10]魏晓.急性ST抬高心肌梗死心电图心肌缺血分级的临床研究[J].现代诊断与治疗,2014,25(5):1108.
[11]林晓明,杨希立,刘鹤龄,等.缺血分级在急性ST段抬高型心肌梗死的临床价值[J].岭南心血管病杂志,2016,22(1):30.