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目的 探讨急性前壁心肌梗死行直接经皮冠状动脉血运重建术 (PCI)后心电图ST段持续抬高对心梗后晚期左室功能和临床预后的影响。方法 选择因急性前壁心肌梗死入院接受急诊PCI的患者 72例 ,动态观察PCI术前后心电图ST段的变化 ,以PCI术后 1hST段下降大于 5 0 %为ST段下降组 ,相反为ST段抬高组。应用超声心动图测定心梗后早期 (2～ 3周 )和晚期 (5～ 6个月 )左室功能和室壁活动异常的变化 ,并随访其间心血管事件的发生率。结果 ST段下降组 5 3例 (74 % ) ,ST段抬高组 19例(2 6 % )。心梗后早期两组间左室功能和室壁活动异常无明显差异 ;晚期ST段抬高组LVEF明显低于ST段下降组 (P <0 .0 5 ) ,而LVEDVI、LVESVI和VWMA积分均明显高于ST段下降组 (P <0 .0 5 ,P <0 .0 1)。随访期间ST段抬高组主要心血管事件的发生率略高于ST段下降组 ,但差异无统计学意义。ST段下降组梗死前心绞痛和直接支架术的比例明显高于ST段抬高组 (P <0 .0 5 )。结论 急性前壁心肌梗死成功直接PCI后ST段持续性抬高者心梗后晚期左室功能较差。有梗死前心绞痛和直接支架术者PCI术后ST段持续性抬高的发生率可能较低
Objective To investigate the effect of continuous elevation of ST segment of ST segment on left ventricular function and clinical prognosis after acute percutaneous coronary intervention in patients with acute anterior myocardial infarction (AMI). Methods Seventy-two patients admitted to hospital for emergency PCI undergoing acute anterior myocardial infarction (MI) were enrolled in this study. The changes of ST segment before and after PCI were observed. The ST segment decreased more than 50% at 1 h after PCI, Elevated group. The changes of left ventricular function and ventricular wall motion abnormalities in the early (2-3 weeks) and late (5-6 months) after myocardial infarction were measured by echocardiography, and the incidence of cardiovascular events was followed up. Results There were 53 cases (74%) in the ST segment depression group and 19 cases (26%) in the ST segment elevation group. There was no significant difference in left ventricular function and ventricular wall motion between the two groups in the early stage of myocardial infarction. The LVEF in the late ST-segment elevation group was significantly lower than that in the ST-segment depression group (P <0.05), while LVEDVI, LVESVI and VWMA scores were significantly higher Which was higher than that in ST segment depression group (P <0.05, P <0.01). During the follow-up period, the incidence of major cardiovascular events in the ST segment elevation group was slightly higher than that in the ST segment depression group, but the difference was not statistically significant. The ratio of pre-infarction angina and direct stenting in ST segment depression was significantly higher than that in ST segment elevation (P <0.05). Conclusion The success of acute anterior myocardial infarction in patients with persistent ST-segment elevation after PCI is poor in late-stage left ventricular function. Pre-infarction angina and direct stenting may have a lower incidence of persistent ST-segment elevation after PCI