中华心血管病杂志
中華心血管病雜誌
중화심혈관병잡지
Chinese Journal of Cardiology
2014年
5期
400-405
,共6页
冠状动脉疾病%心电描记术%血管成形术,经腔,经皮冠状动脉
冠狀動脈疾病%心電描記術%血管成形術,經腔,經皮冠狀動脈
관상동맥질병%심전묘기술%혈관성형술,경강,경피관상동맥
Coronary disease%Electrocardiography%Angioplasty,transluminal,percutaneous coronary
目的 探讨心电图碎裂QRS波(fQRS)与ST段抬高型心肌梗死患者急诊经皮冠状动脉介入治疗(PCI)后心电图ST段回落不良的关系.方法 连续纳入因ST段抬高型心肌梗死接受急诊PCI的患者共227例,其中心电图存在fQRS患者142例(fQRS组),无fQRS患者85例(无fQRS组).分析患者的一般临床资料、Gensini评分、冠状动脉造影参数、心电图ST段回落率.结果 (1)与无fQRS组比较,fQRS组患者肌钙蛋白I(cTnI)、肌酸激酶(CK)、肌酸激酶同工酶(CK-MB)水平和Gensini评分较高,QRS间期较长,ST段回落率、左心室射血分数较低(P＜0.01或0.05).(2)Pearson相关分析显示,心电图是否存在fQRS与ST段回落率(r=-0.207,P=0.002)、Gensini评分(r=0.191,P=0.004)、左心室射血分数(r=-0.188,P=0.006)、cTnI(r =0.172,P=0.010)、术后梗死相关动脉恢复至TIMI 3级(r=-0.148,P=0.028)有关.(3)多因素logistic回归分析显示,术前有无fQRS(OR =2.908,95％CI:1.095～7.723,P=0.032)、术前fQRS导联数(OR=1.582,95％CI:1.250～2.002,P＜0.001)、QRS间期增量(OR =0.955,95％CI:0.924～0.988,P=0.008)与术后ST段回落不良独立相关.结论 fQRS与ST段抬高型心肌梗死患者急诊PCI术后ST段回落不良有关,可用于识别具有严重冠状动脉病变、大面积心肌坏死或损伤、左心室收缩功能不良的高风险ST段抬高型心肌梗死患者.
目的 探討心電圖碎裂QRS波(fQRS)與ST段抬高型心肌梗死患者急診經皮冠狀動脈介入治療(PCI)後心電圖ST段迴落不良的關繫.方法 連續納入因ST段抬高型心肌梗死接受急診PCI的患者共227例,其中心電圖存在fQRS患者142例(fQRS組),無fQRS患者85例(無fQRS組).分析患者的一般臨床資料、Gensini評分、冠狀動脈造影參數、心電圖ST段迴落率.結果 (1)與無fQRS組比較,fQRS組患者肌鈣蛋白I(cTnI)、肌痠激酶(CK)、肌痠激酶同工酶(CK-MB)水平和Gensini評分較高,QRS間期較長,ST段迴落率、左心室射血分數較低(P＜0.01或0.05).(2)Pearson相關分析顯示,心電圖是否存在fQRS與ST段迴落率(r=-0.207,P=0.002)、Gensini評分(r=0.191,P=0.004)、左心室射血分數(r=-0.188,P=0.006)、cTnI(r =0.172,P=0.010)、術後梗死相關動脈恢複至TIMI 3級(r=-0.148,P=0.028)有關.(3)多因素logistic迴歸分析顯示,術前有無fQRS(OR =2.908,95％CI:1.095～7.723,P=0.032)、術前fQRS導聯數(OR=1.582,95％CI:1.250～2.002,P＜0.001)、QRS間期增量(OR =0.955,95％CI:0.924～0.988,P=0.008)與術後ST段迴落不良獨立相關.結論 fQRS與ST段抬高型心肌梗死患者急診PCI術後ST段迴落不良有關,可用于識彆具有嚴重冠狀動脈病變、大麵積心肌壞死或損傷、左心室收縮功能不良的高風險ST段抬高型心肌梗死患者.
목적 탐토심전도쇄렬QRS파(fQRS)여ST단태고형심기경사환자급진경피관상동맥개입치료(PCI)후심전도ST단회락불량적관계.방법 련속납입인ST단태고형심기경사접수급진PCI적환자공227례,기중심전도존재fQRS환자142례(fQRS조),무fQRS환자85례(무fQRS조).분석환자적일반림상자료、Gensini평분、관상동맥조영삼수、심전도ST단회락솔.결과 (1)여무fQRS조비교,fQRS조환자기개단백I(cTnI)、기산격매(CK)、기산격매동공매(CK-MB)수평화Gensini평분교고,QRS간기교장,ST단회락솔、좌심실사혈분수교저(P＜0.01혹0.05).(2)Pearson상관분석현시,심전도시부존재fQRS여ST단회락솔(r=-0.207,P=0.002)、Gensini평분(r=0.191,P=0.004)、좌심실사혈분수(r=-0.188,P=0.006)、cTnI(r =0.172,P=0.010)、술후경사상관동맥회복지TIMI 3급(r=-0.148,P=0.028)유관.(3)다인소logistic회귀분석현시,술전유무fQRS(OR =2.908,95％CI:1.095～7.723,P=0.032)、술전fQRS도련수(OR=1.582,95％CI:1.250～2.002,P＜0.001)、QRS간기증량(OR =0.955,95％CI:0.924～0.988,P=0.008)여술후ST단회락불량독립상관.결론 fQRS여ST단태고형심기경사환자급진PCI술후ST단회락불량유관,가용우식별구유엄중관상동맥병변、대면적심기배사혹손상、좌심실수축공능불량적고풍험ST단태고형심기경사환자.
Objective To explore the relationship between fragmented QRS complexes (fQRS)and imperfect ST-segment resolution in ST elevation myocardial infarction (STEMI) patients undergoing primary percutaneous coronary intervention (p-PCI).Methods This study included 227 consecutive patients with STEMI who underwent p-PCI.They were divided into two groups:ECG with fQRS (n =142)and without fQRS (n =85).Baseline clinical characteristics,Gensini score,coronary angiography features and the rate of ST-segment resolution were compared between the two groups.Results (1) Patients with fQRS of ECG had higher cTnI,CK,CK-MB levels and Gensini score,prolonged QRS interval,lower rate of ST-segment resolution and left ventricular ejection fraction (LVEF) than in patients without fQRS (all P ＜ 0.01 or P ＜ 0.05).(2) Pearson correlation analysis showed that the rate of ST-segment resolution (r =-0.207,P =0.002),Gensini score (r =0.191,P =0.004),LVEF (r =-0.188,P =0.006),cTnI (r =0.172,P =0.010),and the TIMI grade post p-PCI (r =-0.148,P =0.028) were significantly related with the presence of fQRS.(3) Multivariate logistic regression analysis demonstrated that presence of fQRS at pre-PCI (OR =2.908,95％ CI:1.095-7.723,P =0.032),the number of leads with fQRS before PCI (OR =1.582,95％ CI:1.250-2.002,P ＜ 0.001),and increased QRS interval (OR =0.955,95％ CI:0.924-0.988,P =0.008) were independent predictors of imperfect ST-segment resolution.Conclusions fQRS is related to imperfect ST-segment resolution in STEMI patients undergoing p-PCI.fQRS may be a useful parameter to identify the patients with severe coronary lesion,larger areas of ischemic injury and myocardial infarction as well as severe left ventricular contracted dysfunction.
