作者：叶旭东，彭瑜，张钲

单位：

1.兰州大学第一医院心脏中心2.甘肃省心血管疾病重点实验室

Units：

1.Heart Center, the First Hospital of Lanzhou University, Lanzhou 730000, China 2.Key Laboratory of Cardiovascular Diseases of Gansu Province, Lanzhou 730000, China

关键词：

心肌梗死; 主要不良心血管事件; 心电图; aVR导联T波直立;

Keywords：

Myocardial infarction; Major adverse cardiac events; Electrocardiogram; Positive T wave in lead aVR

CLC：

R 542.22

DOI：

10.12114/j.issn.1008-5971.2023.00.104

Funds：

甘肃省科技计划项目（18JR2FA005）；

摘要：

目的 探讨aVR导联T波直立与急性心肌梗死（AMI）患者PCI后发生主要不良心血管事件（MACE的关系。方法 回顾性选取2021年1—7月兰州大学第一医院收治的AMI患者595例。收集患者一般资料、临床资料、MACE发生情况。采用多因素Logistic回归分析探讨AMI患者PCI后发生院内MACE及出院后1年内发生MACE的影响因素。结果 595例患者中，41例发生院内MACE（心源性死亡18例，心源性休克13例，室性心律失常10例），将其作为A组，其余患者作为B组；577例出院患者中，63例出院后1年内发生MACE（心源性死亡1例，心力衰竭23例，复发心绞痛39例），将其作为C组，其余患者作为D组。A组年龄、有糖尿病史者占比、血肌酐、血糖、N末端脑钠肽前体（NT-proBNP）、aVR导联T波直立者占比高于B组，左心室射血分数（LVEF）低于B组，入门至球囊扩张时间（D2B）、住院时间长于B组，病变血管支数多于B组（P<0.05）。C组有糖尿病史者占比、血糖、aVR导联T波直立者占比高于D组，病变血管支数多于D组（P<0.05）。多因素Logistic回归分析结果显示，LVEF、D2B、aVR导联T波直立是AMI患者PCI后发生院内MACE的影响因素，病变血管支数、aVR导联T波直立是AMI患者出院后1年内发生MACE的影响因素（P<0.05）。结论 aVR导联T波直立是AMI患者PCI后发生院内MACE及出院后1年内发生MACE的危险因素。

Abstract：

Objective To investigate the correlation between positive T wave in lead aVR and major adverse cardiovascular events (MACE) in patients with acute myocardial infarction (AMI) after PCI. Methods A total of 595 patients with AMI admitted to the First Hospital of Lanzhou University from January to July 2021 were retrospectively selected. General data, clinical data and occurrence of MACE of patients were collected. Multivariate Logistic regression analysis was used to investigate the influencing factors of in-hospital MACE after PCI and MACE within 1 year after discharge in AMI patients. Results Among the 595 patients, 41 developed MACE in hospital (18 cases of cardiac death, 13 cases of cardiogenic shock, 10 cases of ventricular arrhythmia) and were assigned as group A and the rest as group B. Among 577 discharged patients, 63 developed MACE (1 cardiogenic death, 23 heart failure, 39 recurrent angina) within 1 year after discharge and were classified as group C and the rest as group D. Age, the proportion of patients with diabetes history, creatinine, blood glucose, N-terminal pro-brain natriuretic peptide (NT-proBNP) , the proportion of patients with positive T wave in lead aVR in group A were higher than those in group B, left ventricular ejection fraction (LVEF) was lower than that in group B, door to balloon (D2B) and the time of hospital stay were longer than those in group B, and the number of diseased vessels was more than that in group B (P < 0.05) . The proportion of patients with diabetes history, blood glucose and the proportion of patients with positive T wave in lead aVR in group C were higher than those in group D, and the number of diseased vessels was more than that in group D (P < 0.05) . Multivariate Logistic regression analysis showed that LVEF, D2B and positve T wave in lead aVR were the influencing factors of in-hospital MACE in AMI patients after PCI, and the number of diseased vessels and positive T wave in lead aVR were the influencing factors of MACE in patients with AMI within 1 year after discharge (P < 0.05) . Conclusion Positive T wave in lead aVR is a risk factor for inhospital MACE after PCI and MACE within 1 year after discharge in patients with AMI.

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