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入院心电图无缺血改变的非ST段抬高型心肌梗死患者预后分析

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目的 探讨非ST段抬高型急性心肌梗死(NSTEMI)患者入院心电图无缺血改变的发生
率及其对预后的影响。方法 回顾性分析2014年1月至2017年12月于丹阳市人民医院心内科住院的192
例NSTEMI患者,根据急诊室12或18导联心电图表现,分为两组,即无缺血改变组及ST段压低组。了
解NSTEMI患者心电图无缺血改变的发生率,住院期间及出院30 d心血管复合终点事件发生率。结果
和ST段压低组相比,无缺血改变组多年纪轻,有近期吸烟史,心血管危险因素少。无缺血性改变组
(n=110,57.3%)明显高于ST段压低组(n=82,42.7%)。无缺血改变组3支血管病变发生率低于ST
段压低组(28.2% vs. 41.5%,P=0.003),左主干(7.3% vs. 24.4%,P=0.000)及前降支近端病变发生率
(30.9% vs. 41.5%,P=0.027)低于ST段压低组,无缺血改变组D-to-B时间(h)明显高于ST段压低组
[(30.88±18.29)vs.(14.61±6.25),P=0.000]。住院期间MACE低于ST段压低组,但是30 d MACE两者
无明显差别。结论 根据入院心电图检查的结果,NSTEMI患者心电图无缺血改变发生率高、短期预后较
ST段压低组好,但仍需要引起高度关注,及时实现再灌注治疗可能会改善预后。

Abstract:

Objective To investigate the incidence of non-ischemic changes in patients with non-STsegment
elevation acute myocardial infarction (NSTEMI) and its impact on prognosis. Methods From January
2014 to December 2017, 192 patients with NSTEMI who were admitted to the Department of Cardiology of Danyang
People's Hospital were divided into no ischemia group and ST group depression group according to the 12 or 18 lead
electrocardiogram in the emergency department. The incidence of non-ischemic changes in the electrocardiogram
of patients with NSTEMI, the incidence of cardiovascular composite endpoints during hospitalization and 30 days of
discharge were recorded. Results Compared with the ST-segment depression group, the non-ischemic change group
was lighter in age, had a recent history of smoking, and had fewer cardiovascular risk factors. There was no ischemic
change group (n=110, 57.3%), and the incidence was significantly higher than that of the ST segment depression group
(n=82, 42.7%). The incidence of 3-vessel disease in the non-ischemic change group was lower than that in the STsegment
depression group (28.2% vs. 41.5%, P=0.003), left main (7.3% vs. 24.4%, P=0.000) and proximal anterior
descending The incidence of lesions (30.9% vs. 41.5%, P=0.027) was lower than that in the ST-segment depression
group, and the D-to-B time (h) in the no-ischemia group was significantly higher than that in the ST-segment
depression group ((30.88±18.29) vs. (14.61 ± 6.25), P=0.000). The MACE during hospitalization was lower than
the ST-segment depression group, but there was no significant difference between the 30-day MACE. Conclusion
According to the results of ECG examination, the incidence of ischemia-free electrocardiogram in patients with
NSTEMI is high, and the short-term prognosis is better than that in the ST-segment depression group. However, it still
needs to be highly concerned, and timely reperfusion therapy may improve the prognosis.

基金项目:

江苏省镇江市卫生科技重点专项项目(SHW2015020)

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