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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 changes of heart rate-corrected T-wave peak before and after percutaneous coronary intervention (PCI) in patients with acute ST-elevation myocardial infarction (STEMI) and its relationship with malignant ventricular arrhythmias (MVA) relationship. Methods: A total of 494 STEMI patients were enrolled in this study. Tpec was recorded before PCI and after PCI (1 h, 6 h, 12 h, 24 h, 48 h). The incidence of MVA was compared between the two groups according to whether the Tpec was reduced to 100 ms after PCI and the patients were divided into Tpec≥100 ms group (n = 73) and Tpec <100 ms group (n = 421). According to the occurrence of MVA after PCI, patients were divided into two groups: MVA group (n = 94) and MVA group (n = 400). The relationship between Tpec and MVA before and after PCI was analyzed. Logistic regression analysis was used to analyze the risk factors of MVA. Results: After PCI, the incidence of MVA in Tpec≥100 ms group was significantly higher than that in Tpec <100 ms group (34.2% vs 9.3%, P <0.05). After PCI, Tpec decreased slowly and fluctuated in patients with MVA. The patients without MVA showed a trend of decreasing gradually (P <0.05) after 100 h. Tpec persistence of more than 100 ms after PCI was an independent risk factor for MVA (odds ratio = 4.79, 95% confidence interval: 2.28-10.08, P <0.05). CONCLUSIONS: The sustained decrease of Tpec (≥100 ms) after PCI in STEMI patients is a risk factor for MVA, which may be of reference value for risk stratification in patients with STEMI.