摘要
目的:分析右胸V_4R导联ST段抬高在急性前壁ST段抬高型心肌梗死(ST-elevation myocardial infarction,STEMI)的临床价值。方法:入选2017年1月至2018年7月在我院住院的接受经皮冠状动脉介入(percutaneous coronary intervention,PCI)治疗的急性前壁STEMI的患者96例,其中男性82例,女性14例,平均年龄(56±11)岁。根据患者入院时心电图右胸V_4R导联抬高程度分V_4R ST段抬高≥1.0 mm与V_4R ST段抬高<1.0 mm 2组,观察2组患者心脏超声、冠状动脉造影结果及主要不良事件(包括PCI术前室性心动过速/心室颤动及住院期间心力衰竭及心血管死亡)的发生情况。结果:与V_4R ST段抬高<1.0 mm组患者相比,V_4R ST段抬高≥1.0 mm患者收缩压及射血分数偏低,全球急性冠状动脉事件注册(global registry of acute coronary events,GRACE)评分及心肌梗死溶栓(thrombolysis in myocardial infarction,TIMI)评分较高,Killip分级>1患者比例、心脏前间壁中段运动障碍比例及合并多血管病变比例较高(均P<0.05)。V_4R ST段抬高≥1.0 mm组患者发生PCI术前室性心动过速/心室颤动、住院期间出现心力衰竭及复合事件的比例均高于V_4R ST段抬高<1.0 mm组(均P<0.05)。多因素Logistic回归分析显示与V_4R ST段抬高<1.0 mm患者相比,V_4R ST段抬高≥1.0 mm患者PCI术前室性心动过速/心室颤动增加2.76倍,住院期间心力衰竭增加3.29倍,复合事件增加5.88倍。结论:急性前壁STEMI患者右胸V_4R导联ST段抬高≥1.0 mm是患者住院期间发生不良事件的危险因素,预后较差。
Objective To explore the significance of right precordial lead(V_4R) ST-segment(V_4RST) elevation in diagnosis of acute anterior ST-segment elevation myocardial infarction(STEMI). Methods A total of 96 patients, including82 males and 14 females, with acute anterior STEMI were enrolled from January 2017 through July 2018. The average age of patients was(56±11) years. Patients were divided into two groups based on V_4R ST elevation of either ≥1.0 mm or <1.0 mm. The results of cardiac ultrasound and coronary angiography were assessed. The adverse events including ventricular tachycardia(VT) or ventricular fibrillation(VF) occurring before coronary intervention, acute heart failure occurrence and cardiovascular death during hospitalization. Results Patient with V_4R ST elevation(≥1.0 mm) had a lower systolic blood pressure and left ventricular ejection fraction, higher global registry of acute coronary events(GRACE) score and thrombol-ysis in myocardial infarction(TIMI) score, and higher proportion of Killip class >1 and middle anteroseptal segmental wall motion abnormality. The incidences of VT/VF before coronary intervention and acute heart failure were significant higher in patient with V_4R ST≥1.0 mm(P<0.05). Multivariable Logistic regression analyses revealed significant association of V_4R ST elevation with VT/VF events prior coronary intervention [hazard ratio(HR) 2.76, 95% confidence interval(CI): 0.96 to 10.19, P=0.021] and acute heart failure(HR 3.29, 95% CI: 0.83 to 13.09, P=0.032) independently, and combined(HR5.88, 95% CI: 2.61 to 28.8, P =0.011). Conclusions Right precordial lead V_4R ST elevation is associated with adverse events in patients with acute anterior STEMI.
引文
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