CAJ | 학술논문

目的：探讨入院后行急诊经皮冠状动脉介入治疗（PCI）胸前导联ST段抬高的急性心肌梗死患者入院时心率对患者临床预后的评价。方法2010年3月至2012年2月合并有胸前导联ST段抬高且入院后行急诊PCI的患者208例，按照入院时心电图心室率分为低心室率组（心率≤70次/min）和高心室率组（心率>70次/min），低心室率组64例，高心室率组144例。比较两组患者发病至病变血管开通时间，冠脉病变情况、入院时心超射血分数（EF）值以及临床远期预后情况。结果高心室率组发病至病变血管开通时间较低心室率组长。入院时高心室率组的心功能分级高，心超EF值低。冠脉造影发现，高心室率组多支病变发生率较低心室率组高。在出院后2年的随访中，患者因心力衰竭，再发心肌梗死、猝死的心血管事件发生率在高心室率组较低心室率组高（高心室率组共34例，低心室率组共10例）。结论入院时心室率快的急性胸前导联ST段抬高的患者自发病至病变血管开通时间长，冠脉病变严重，心功能差，且远期预后较差。
목적：탐토입원후행급진경피관상동맥개입치료（PCI）흉전도련ST단태고적급성심기경사환자입원시심솔대환자림상예후적평개。방법2010년3월지2012년2월합병유흉전도련ST단태고차입원후행급진PCI적환자208례，안조입원시심전도심실솔분위저심실솔조（심솔≤70차/min）화고심실솔조（심솔>70차/min），저심실솔조64례，고심실솔조144례。비교량조환자발병지병변혈관개통시간，관맥병변정황、입원시심초사혈분수（EF）치이급림상원기예후정황。결과고심실솔조발병지병변혈관개통시간교저심실솔조장。입원시고심실솔조적심공능분급고，심초EF치저。관맥조영발현，고심실솔조다지병변발생솔교저심실솔조고。재출원후2년적수방중，환자인심력쇠갈，재발심기경사、졸사적심혈관사건발생솔재고심실솔조교저심실솔조고（고심실솔조공34례，저심실솔조공10례）。결론입원시심실솔쾌적급성흉전도련ST단태고적환자자발병지병변혈관개통시간장，관맥병변엄중，심공능차，차원기예후교차。
Objective To assess the prognostic impact of admission heart rate in patients with precordial ST-elevation myocardial infarction undergoing acute percutaneous coronary intervention.Methods Restrospective analysis of prospectively collected data on 208 PCI-treated STEMI patients between March 2010 and February 2012.208 patients were divided according to the admission heart rate into either low rate group(≤70bpm, n=64)or high rate group(>70bpm,n=144).The time from illness to operation,coronary disease,left ventricular ejection fraction of admission into hospital and long-term progrosis were compared between the two groups.Results Patients with heart rate>70bpm had a longer time from illness to operation,higher cardiac function and lower ejection fraction.The results of coronary angiography showed that both two groups patients were present with left anterior descending artery lesions,and there were significant differences between high rate group and low rate group with regard to the incidence rates(41.7%VS31.3%).During a follow-up period of two years,cardiac events(heart failure,reinfarction,sudden death) was recorded in 44 patients,34(23.6%)in the high heart rate group compared to 10 patients in the high heart group.Conclusion As long as heart rate increased,the time from illness to operation was longer,coronary disease was more severe ,cardiac fraction gradually decreased and long-term prognosis was worse.