Objective To explore the clinical values of ST-segment changes in ST-segment elevated myocardial infarction (STEMI) patients within 24 hours after primary percutaneous coronary intervention (PCI).Methods A total of 225 patients with STEMI underwent primary PCI were enrolled,the ST segment resolution 1 hour after PCI was calculated and the patients were divided into group A (n =135,∑STE resolved ≥ 50％) and group B (n =90,∑STE resolved ＜ 50％).The patients in group B were further divided into group C (n =56,∑STE resolved ≥ 50％) and group D (n =34,∑STE resolved ＜ 50％) according to the ST segment resolution at 24 hours after PCI.TIMI flow after PCI,in-hospital major adverse cardiac events(MACE) and cardiac function about 7 days post PCI were analyzed.Results Data between group A and group B were similar except the incidence of pre-PCI Killip ≥ Ⅱ was significantly higher in group B than in group A (37.8％ (34/90) vs.17.0％ (23/135),P ＜ 0.05).Incidence of complicated diabetes (P ＜0.05),pre-PCI Killip≥ Ⅱ (55.9％ (19/34) vs.26.8％ (15/56),P ＜0.05) and multivessel disease(70.6％ (24/34) vs.35.7％ (20/56),P ＜ 0.05) were significantly higher in group D than in group C.TIMI 3 and the opening time of IRA was similar between group A and group B and between group C and group D.The incidence of in-hospital MACE was significantly higher in group B than in group A (14.4％ (13/90) vs.3.0％ (4/135),P ＜ 0.05) which was similar between group C and group D.Conclusion Early (1 hour) but not late (24 hours) ST resolution post PCI is related to a favorable clinical outcome in STEMI patients.%目的 探讨ST段抬高型急性心肌梗死(STEMI)急诊经皮冠状动脉介入(PCI)术后24h内心电图ST段演变的临床意义.方法 2012年6月至2013年12月就诊中国医科大学第一附属医院的225例STEMI患者,按照PCI术后1h心电图ST段抬高振幅总和(∑STE)较术前下降是否≥50％分为A组(≥50％,135例)及B组(＜50％,90例),分析PCI后冠状动脉TIMI血流、ST段回落和住院期间术后1周左心室射血分数(LVEF)、住院期间主要心血管不良事件(MACE)的关系.继续观察B组心电图至术后24h,按术后24 h∑STE较术前下降是否≥50％分为C组(≥50％,56例)及D组(＜50％,34例),同样分析这两组患者心电图ST段延迟回落和预后的相关性.结果 A、B两组间年龄、性别等一般资料比较差异均无统计学意义,仅术前Killip≥Ⅱ级B组高于A组[37.8％(34/90)比17.0％(23/135),P＜0.05];C、D两组间年龄、性别等一般资料比较差异均无统计学意义,而合并糖尿病比例D组高于C组(P＜0.05),D组术前Killip≥Ⅱ级[55.9％(19/34)比26.8％(15/56),P＜0.05]和多支血管病变比例[70.6％(24/34)比35.7％ (20/56),P＜0.05]均高于C组,A、B两组差异无统计学意义.TIMI 3级血流比例、发病至冠状动脉开通时间A、B两组及C、D两组比较差异均无统计学意义.住院期间总MACE发生率B组高于A组[14.4％ (13/90)比3.0％(4/135),P＜0.05],C、D两组术后1周LVEF、住院期间MACE发生率及各个事件分别比较差异均无统计学意义.结论 STEMI患者急诊PCI术后心电图ST段的早期回落可能反映心肌灌注水平,协助评价早期预后,而术后24 h ST段的延迟回落无同样价值.
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