目的:探讨急性ST段抬高型心肌梗死(STEMI)患者经皮冠状动脉介入治疗(PCI)前后心率校正的T波峰末间期(Tpec)变化过程及其与恶性室性心律失常(MVA)的关系.方法:纳入接受PCI的STEMI患者494例,分别在PCI前、PCI后(1 h、6 h、12 h、24 h、48 h)、出院时记录Tpec.根据患者PCI后Tpec是否降至100 ms分为Tpec≥100 ms组(n=73)和Tpec<100 ms组(n=421),比较两组患者的MVA发生率.根据患者PCI后是否发生MVA又分为MVA组(n=94)和无MVA组(n=400),分析PCI前后Tpec变化过程与MVA发生的关系.采用Logistic多因素回归分析发生MVA的危险因素.结果:STEMI患者PCI后,Tpec≥100 ms组较Tpec<100 ms组的MVA发生率明显增高(34.2%vs 9.3%,P<0.05).发生MVA的STEMI患者PCI后Tpec降低缓慢且呈波动趋势,而无MVA的患者在术后6 h即降至100 ms以下,呈逐渐下降趋势(P<0.05).PCI后Tpec持续高于100 ms是发生MVA的独立危险因素(比值比=4.79,95%可信区间:2.28~10.08,P<0.05).结论:STEMI患者PCI后Tpec持续降低缓慢(≥100 ms)是发生MVA的危险因素,对于STEMI患者的危险分层具有一定参考价值.
Objective: To investigate the changing process of Tpeak-Tend interval (Tpec) in acute ST-elevation myocardial infarction (STEMI) patients before and after percutaneous coronary intervention (PCI) with the relationship to malignant ventricular arrhythmias (MVA). Methods: A total of 494 acute STEMI patients with PCI were enrolled. Tpec was recorded before PCI; 1h, 6h, 12h, 48h post-PCI and at the time of discharge. According to weather post-PCI Tpec reduced to 100 ms, the patients were divided into 2 groups: Tpec≥100 ms group,n=73 and Tpec<100 ms group,n=421, the incidence rate of MVA was compared between 2 groups. Based on post-PCI MVA occurrence, the patients were divided into another set of 2 groups: MVA group,n=94 and Non-MVA group,n=400, the changing process of Tpec before and after PCI with the relationship to MVA were assessed. Risk factors for MVA occurrence were studied by multivariate Logistic regression analysis. Results: The post-PCI incidence rate of MVA was higher in Tpec≥100 ms group than Tpec<100 ms group (34.2% vs 9.3%),P<0.05. In MVA group, Tpec was slowly decreased with lfuctuation trend; in Non-MVA group, Tpec was decreased to<100 ms at 6h post-PCI with gradually decline trend,P<0.05. After PCI, Tpec≥100 ms persistently was the independent risk factor for MVA occurrence (OR=4.79, 95% CI 2.28-10.08,P<0.05).Conclusion: Post-PCI Tpec persistently and slowly decreasing (≥100ms) was a risk factor for MVA occurrence in acute STEMI patients, which had certain reference value for the risk stratiifcation in clinical practice.