非梗死相关导联ST段压低预测AMI再灌注治疗长期预后的价值.docVIP

非梗死相关导联ST段压低预测AMI再灌注治疗长期预后的价值 　　作者：冯生杰　杨旭　许桂枝　张希勇　张宏涛 　　作者单位： 450007 河南郑州 解放军第460医院心内科 　　【摘要】目的探讨持续性非梗死相关导联(NIRL)ST段压低对AMI再灌注治疗长期预后的价值。方法根据183例AMI溶栓和(或)PCI术后冠脉再灌注后有无NIRL持续性ST 段压低情况，将患者分为两组：组1：持续性ST段压低组54例;组2：一过性ST段压低或无ST段压低组129例。分析NIRL持续性ST段压低对AMI 再灌注后12～50个月(平均26个月)的心血管事件发生率(心绞痛、AMI、PCI术、冠脉搭桥)、死亡率及生存率的影响。结果持续性的ST 段压低组与一过性ST段压低或无ST段压低组心血管事件发生率分别为：心绞痛40.7%与12.4%;AMI 22.5%与4.7%;PCI 18.5%与6.2%;冠脉搭桥5.6%与1.6%(P=0.0001)。总死亡率分别为38.9%与11.6%(P=0.0001)。生存率分别为：59.6%与87.7%(P=0.0001)。结论AMI患者再灌注后NIRL持续性ST段压低者，心血管事件发生率高、死亡率高、生存率低，它是预测AMI患者再灌注治疗长期预后的重要指标，它对临床确定AMI再灌注治疗后患者近期和远期的疾病转归具有潜在的重要价值。 　　关键词:ST段压低心电图;急性心肌梗死;冠脉再灌注治疗预后 　　Predict on long-term prognosis of persistent ST-segment depression in non-infarct-related-leads after reperfusion therapy in acute myocardial infarction 　　Feng Shengjie，Yang Xu，Xu Guizhi，et al. 　　The 460th Hospital of PLA，Zhengzhou 450007. 　　【Abstract】ObjectiveTo evaluate long-term prognosis of ST-segment depression in non-infarct-related-leads (NIRL) in patients who received reperfusion therapy after acute myocardial infarction (AMI).Methods183 consecutive patients who were admitted with AMI and underwent reperfusion therapy were evaluated.Patients were followed up for an average of 26 months(12～50 months) and were classified 2 groups: group 1 had 54 patients with persistent ST-segment depression，and group 2 included 129 patients with transient or without ST-segment depression.Cardiovascular events and deaths rates were analyzed.ResultsGroup 1 had significantly worse long-term prognosis versus group 2. Cardiovascular events of group 1 versus 2 were respectively:angina:40.7% VS 12.4%,AMI:22.5% VS 4.7%; PCI:18.5% VS 6.2%,CABG:5.6% VS 1.6%(P=0.0001).Total mortality of group 1 VS group 2 were respectively 38.9% VS 12.6%(P=0.0001). Survival probability of group 1 VS group 2 were respectively 59.6% VS 87.7%(P=0.0001).ConclusionIt is worse long-term prognosis that NIRL persistent ST-segment depression in patients who received reperfusion