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目的研究急性心肌梗死患者PCI术后QT离散度(QTd)变化与急性心肌梗死(AMI)患者预后评估的相关性。方法选取内科接受急诊PCI治疗的急性心肌梗死患者32例,于入院后6h内采用Judkin’8法进行选择性冠状动脉造影及经皮冠状动脉介入治疗(PCI);并与11例同期冠状动脉造影术(CAG)结果正常者(对照组)进行比较,对照分析术前2h和术后24h的标准十二导联同步心电图QTd及随访发病30d内的主要心血管事件(MACE)。结果与治疗前相比,PCI组治疗后QTd明显缩短,二者差异有统计学意义(P<0.01),对照组治疗前后比较无统计学意义(P>0.05);与对照组比较,PCI组治疗前差异无统计学意义(P>0.05),PCI组治疗后QTd明显缩短,差异有统计学意义(P<0.01);所有行急诊PCI治疗32例AMI患者出现QTd缩短的患者有23例,随访30d心血管事件发生率为25%(8/32),QTd未见明显改变的患者9例心血管事件发生率77.8%(7/9),二者差异有统计学意义(P<0.01)。结论 AMI患者QTd明显高于正常人,成功的PCI,能显著减小AMI患者QTd及心血管事件发生率;QTd及其变化程度,可作为评价心肌灌注及近期预后的预测指标。
Objective To investigate the relationship between QTd changes and the prognosis of patients with acute myocardial infarction (AMI) after percutaneous coronary intervention in patients with acute myocardial infarction. Methods Thirty-two patients with acute myocardial infarction who underwent emergency PCI were enrolled. Selective coronary angiography and percutaneous coronary intervention (PCI) were performed by Judkin’8 within 6 hours after admission. Eleven patients with coronary artery disease (CAG) were compared, and the standard 12-lead synchronous ECG (QTd) and major cardiovascular events (MACE) within 30 days of follow-up were analyzed. Results Compared with those before PCI, the QTd of PCI group was significantly shorter than that before PCI (P <0.01), but there was no significant difference between the two groups (P> 0.05). Compared with the control group, the PCI group There was no significant difference between before and after treatment (P> 0.05). The QTd of PCI group was significantly shorter after treatment (P <0.01), while in all the 32 cases with AMI treated by PCI, there were 23 patients with QTd shortening, The incidence of cardiovascular events was 25% (8/32) at 30 days of follow-up, and the incidence of cardiovascular events was 77.8% (7/9) in 9 patients with no significant changes in QTd. The difference was statistically significant (P <0.01) . Conclusion The QTd of patients with AMI is significantly higher than that of normal people. Successful PCI can significantly reduce the incidence of QTd and cardiovascular events in patients with AMI. QTd and its degree of change can be used as a predictor of myocardial perfusion and prognosis.