急性非ST段抬高型心肌梗死患者aVR导联ST段抬高与SYNTAX评分的关系

doi:10.3969/j.issn.1004-583X.2021.10.013

摘要/Abstract

摘要：

目的探讨急性非ST段抬高型心肌梗死(NSTEMI)患者aVR导联ST段抬高(STEaVR)与STNTAX评分(SS)之间的关系。结论回顾性分析316例NSTEMI患者,对患者总体临床特征、入院时心电图ST段在不同导联的抬高及压低、在院期间超声左心室射血分数和峰值肌钙蛋白I水平等辅助检查以及冠状动脉造影术后所计算的SS进行统计及分析。以是否具有STEaVR对患者进行区组分析,探索STEaVR与SS之间的关系。结果 316例NSTEMI患者中有STEaVR的207例(65.5%),无STEaVR的109例(34.5%)。有STEaVR患者的高SS评分(SS≥23)者比率更高(50.7%比21.1%,P<0.01),左主干和(或)三支病变的发生率更高(43.5%比22.9%,P<0.01)。多因素分析显示,STEaVR(OR=2.640,CI=1.404~4.963,P=0.003)以及前壁导联ST段压低(OR=1.817,CI=1.053~3.135,P=0.032)是高SS的独立预测因素。方法 STEaVR是高SS的独立预测因素。

关键词: ST段抬高型心肌梗死, 心电描记术, 冠状动脉造影术

Abstract:

Objective To explore the relationship between ST-segment elevation in lead aVR(STEaVR) and SYNTAX score(SS) in patients with acute non-ST-segment elevation myocardial infarction(NSTEMI).Methods Totally 316 patients with NSTEMI were retrospectively analyzed. Overall clinical features, electrocardiograms(ECGs) ST elevation and depression in different leads of patients unpon admission, scores and peak values of left ventricle ejection fraction(LVEF), peak troponin Ⅰ level of the patients were counted and analyzed SS after coronary angiography. The patients with or without STEaVR were divied, the relationship between STEaVR and SS were explored.Results The number with STEaVR and without STEaVR in 316 patients was 207 cases (65.5%) and 109 cases (34.5%), respectively;the rate of patients with STEaVR gaining higher SS scores was higher when compared to those without STEaVR (50.7% vs 21.1%; P<0.01),and the incidence of left main coronary artery and/ or three-vessel disease (LM/3VD) was higher (43.5% vs 22.9%; P<0.01). Multivariate analysis showed the independent predictors for higher SS were STEaVR (OR=2.640, CI=1.404-4.963, P=0.003) and precordial ST-segment depression (OR=1.817, CI=1.053-3.135, P=0.032).Conclusion The main independent predictor for higher SS is STEaVR.

Key words: ST elevation myocardial infarction, electrocardiography, angiography

中图分类号:

R541.4

王雅洁, 林文华, 敬锐, 刘菁晶, 卢宇杰. 急性非ST段抬高型心肌梗死患者aVR导联ST段抬高与SYNTAX评分的关系[J]. 临床荟萃, 2021, 36(10): 933-936.

Wang Yajie, Lin Wenhua, Jing Rui, Liu Jingjing, Lu Yujie. Relationship between aVR lead ST-segment elevation with SYNTAX score in patients with acute non-ST-segment elevation myocardial infarction[J]. Clinical Focus, 2021, 36(10): 933-936.

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链接本文: https://huicui.hebmu.edu.cn/CN/10.3969/j.issn.1004-583X.2021.10.013

https://huicui.hebmu.edu.cn/CN/Y2021/V36/I10/933

图/表 3

参考文献 23

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项目	STEaVR		统计值	P值
项目	有(n=207)	无(n=109)	统计值	P值
年龄(岁)	62.2±10.7	58.8±12.4	-2.543	0.011
男性[例(%)]	148(71.5)	79(72.5)	0.034	0.854
高血压[例(%)]	132(63.8)	65(59.6)	0.520	0.471
糖尿病[例(%)]	94(45.4)	27(24.8)	12.873	<0.01
目前仍吸烟[例(%)]	111(53.6)	50(45.9)	1.717	0.19
SYNTAX	23.6±10.4	15.3±8.2	-6.972	<0.01
高SYNTAX评分[例(%)]	105(50.7)	23(21.1)	26.001	<0.01
下壁导联STD[例(%)]	136(65.7)	27(24.8)	47.894	<0.01
侧壁导联STD[例(%)]	137(66.2)	23(21.1)	58.058	<0.01
前壁导联STD[例(%)]	141(68.1)	20(18.3)	70.764	<0.01
左心室射血分数(%)	61.7±6.8	63.6±6.1	-1.219	0.223
LM/3VD[例(%)]	90(43.5)	25(22.9)	13.017	<0.01
峰值TnI(ng/ml)	9.6±12.0	7.5±10.2	-2.519	0.012

项目	STEaVR		统计值	P值
项目	有(n=207)	无(n=109)	统计值	P值
年龄(岁)	62.2±10.7	58.8±12.4	-2.543	0.011
男性[例(%)]	148(71.5)	79(72.5)	0.034	0.854
高血压[例(%)]	132(63.8)	65(59.6)	0.520	0.471
糖尿病[例(%)]	94(45.4)	27(24.8)	12.873	<0.01
目前仍吸烟[例(%)]	111(53.6)	50(45.9)	1.717	0.19
SYNTAX	23.6±10.4	15.3±8.2	-6.972	<0.01
高SYNTAX评分[例(%)]	105(50.7)	23(21.1)	26.001	<0.01
下壁导联STD[例(%)]	136(65.7)	27(24.8)	47.894	<0.01
侧壁导联STD[例(%)]	137(66.2)	23(21.1)	58.058	<0.01
前壁导联STD[例(%)]	141(68.1)	20(18.3)	70.764	<0.01
左心室射血分数(%)	61.7±6.8	63.6±6.1	-1.219	0.223
LM/3VD[例(%)]	90(43.5)	25(22.9)	13.017	<0.01
峰值TnI(ng/ml)	9.6±12.0	7.5±10.2	-2.519	0.012

预测变量	回归系数	标准误	Wald χ²值	P值	OR值	CI
预测变量	回归系数	标准误	Wald χ²值	P值	OR值	下限	上限
年龄	0.025	0.010	5.898	0.015	1.026	1.005	1.047
男性	-0.382	0.253	2.286	0.131	0.683	0.416	1.120
高血压	0.011	0.237	0.002	0.962	1.011	0.636	1.608
糖尿病	0.221	0.235	0.882	0.348	1.247	0.787	1.977
目前仍吸烟	-0.116	0.229	0.258	0.612	0.890	0.568	1.395
STEa VR	1.348	0.273	24.407	<0.01	3.849	2.255	6.570
下壁导联STD	0.583	0.232	6.283	0.012	1.791	1.135	2.824
侧壁导联STD	0.647	0.233	7.731	0.005	1.910	1.210	3.014
前壁导联STD	1.069	0.239	20.019	<0.01	2.913	1.824	4.653

预测变量	回归系数	标准误	Wald χ²值	P值	OR值	CI
预测变量	回归系数	标准误	Wald χ²值	P值	OR值	下限	上限
年龄	0.025	0.010	5.898	0.015	1.026	1.005	1.047
男性	-0.382	0.253	2.286	0.131	0.683	0.416	1.120
高血压	0.011	0.237	0.002	0.962	1.011	0.636	1.608
糖尿病	0.221	0.235	0.882	0.348	1.247	0.787	1.977
目前仍吸烟	-0.116	0.229	0.258	0.612	0.890	0.568	1.395
STEa VR	1.348	0.273	24.407	<0.01	3.849	2.255	6.570
下壁导联STD	0.583	0.232	6.283	0.012	1.791	1.135	2.824
侧壁导联STD	0.647	0.233	7.731	0.005	1.910	1.210	3.014
前壁导联STD	1.069	0.239	20.019	<0.01	2.913	1.824	4.653

预测变量	回归系数	标准误	Wald χ²值	P值	OR值	CI
预测变量	回归系数	标准误	Wald χ²值	P值	OR值	下限	上限
STEa VR	0.971	0.322	9.082	0.003	2.640	1.404	4.963
下壁导联STD	0.053	0.262	0.041	0.839	1.055	0.631	1.764
侧壁导联STD	0.070	0.272	0.065	0.798	1.072	0.629	1.828
前壁导联STD	0.597	0.278	4.610	0.032	1.817	1.053	3.135