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目的结合实验室检测肌钙蛋白Ⅰ与心电图aVR导联ST段抬高情况,探讨二者在非ST段抬高型急性冠状动脉综合征患者的预后评估中的价值。方法入选非ST段抬高型急性冠状动脉综合征患者255例,采血检验肌钙蛋白Ⅰ,并详细测量心电图AVR导联ST段抬高情况,均行冠脉造影,根据具体情况分别行冠脉介入治疗、冠脉搭桥手术及药物保守治疗,随访6个月,观察终点为不良心血管事件,包括心肌梗死(包括再梗)、心血管死亡和血运重建。结果在随访的6个月内,肌钙蛋白Ⅰ值(OR=7.01,95%CI=1.22～12.63,P=0.02)和aVR导联ST段抬高值(OR=1.38,95%CI=1.084～1.751,P=0.009)是患者发生死亡和心肌梗死(包括再梗)的独立危险因素;同时,肌钙蛋白Ⅰ值(OR=1.249,95%CI=1.114～1.501,P<0.01)和aVR导联ST段抬高值(OR=2.03,95%CI=1.20～4.29,P=0.04)亦是患者不良心血管事件(包括死亡、心肌梗死及血运重建术)发生的独立危险因素。在NSTE-ACS患者中,肌钙蛋白Ⅰ的升高的同时aVR导联ST段抬高者,其左主干病变或三支冠状动脉血管病变发生,以及不良心血管事件(包括死亡、心肌梗死、再梗、血运重建)的发生均是最高的。结论在临床中结合肌钙蛋白Ⅰ和心电图aVR导联ST段变化,可以早期应用于非ST段抬高型急性冠状动脉综合征患者预后的判断。
Objective To evaluate the value of ST-segment elevation in troponin I and a-troponin I in laboratory and evaluate their prognostic value in non-ST segment elevation acute coronary syndrome. Methods A total of 255 patients with non-ST-segment elevation acute coronary syndrome (ACS) were included in the study. Blood was taken for troponin I examination. The ST-segment elevation in ECG AVR was measured in detail. Coronary angiography was performed. According to the actual situation, Interventional therapy, coronary artery bypass grafting and drug conservative treatment were followed up for 6 months. The end point was adverse cardiovascular events including myocardial infarction (including re-infarction), cardiovascular death and revascularization. Results Six months after follow-up, the values of troponin I (OR = 7.01, 95% CI = 1.22-12.63, P = 0.02) and ST segment elevation in aVR lead (OR = 1.38, 95% CI = 1.084 ~ 1.751, P = 0.009) were independent risk factors of death and myocardial infarction (including reinfarction). Meanwhile, the values of troponin I (OR = 1.249, 95% CI = 1.114-1.501, P <0.01) and aVR The lead ST segment elevation (OR = 2.03, 95% CI = 1.20-4.29, P = 0.04) was also an independent risk factor for adverse cardiovascular events including death, myocardial infarction and revascularization. In patients with NSTE-ACS, elevated troponin I and elevated aVR lead to ST segment elevation, left main coronary artery disease or three coronary artery disease, and adverse cardiovascular events (including death, myocardial infarction, Re-infarction, revascularization) are the highest incidence. Conclusions The combination of troponin I and ST segment changes in aVR leads of electrocardiogram can be used to judge the prognosis of patients with non-ST segment elevation acute coronary syndrome.