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目的探讨aVR导联ST段抬高在预测首次非ST段抬高型急性心肌梗死患者短期预后中的价值。方法分析426例非ST段抬高型急性心肌梗死患者入院心电图。结果aVR导联无ST段抬高(n=281)、抬高0.05~0.1mV(n=68)和抬高≥0.1mV(n=77)患者的住院死亡率分别是1.8%、7.4%和15.6%。调整基线预测因子和入院时ST段压低的影响,aVR导联ST段抬高0.05~0.1mV和抬高≥0.1mV患者死亡的优势比分别是4.2(95%可信区间为1.4~13.5;P<0.001)和6.1(95%可信区间为2.4~17.3;P<0.001)。住院期间复发心肌缺血事件和心力衰竭发生率随aVR导联ST段抬高程度增加而增加,而不同程度aVR导联ST段抬高患者血清肌酸激酶和肌酸激酶同工酶相似。aVR导联无ST段抬高、抬高0.05~0.1mV和抬高≥0.1mV患者左主干或3支血管病变发生率分别为16.9%、37.1%和56.2%(P<0.001)。结论首次非ST段抬高型急性心肌梗死伴aVR导联ST段抬高患者预后较差,而这种差的预后与严重的冠状动脉病变有关,对这些患者进行早期介入治疗也许有重要的益处。
Objective To investigate the value of aVR lead ST segment elevation in predicting the short-term prognosis of patients with non-ST elevation acute myocardial infarction. Methods The admission electrocardiogram of 426 patients with non-ST elevation acute myocardial infarction was analyzed. Results The in-hospital mortality of patients with aVR without ST segment elevation (n = 281), elevation of 0.05-0.1 mV (n = 68) and elevation of ≥0.1 mV (n = 77) were 1.8% and 7.4% 15.6%. Adjusting for baseline predictors and ST-segment depression at admission, the odds ratios for mortality in the aVR lead with ST-segment elevation of 0.05 to 0.1 mV and elevation of 0.1 mV were 4.2 (95% confidence interval, 1.4 to 13.5; P <0.001) and 6.1 (95% confidence interval 2.4 to 17.3; P <0.001). During hospitalization, the incidence of recurrent myocardial ischemia and heart failure increased with the increase of ST segment elevation in aVR lead, while serum creatine kinase and creatine kinase isoenzyme in ST segment elevation patients with different degrees of aVR were similar. The aVR lead had no ST-segment elevation. The incidence of left main or 3 vessel lesions in patients with elevation of 0.05-0.1 mV and elevation of 0.1 mV were 16.9%, 37.1% and 56.2%, respectively (P <0.001). Conclusions The first non-ST-segment elevation acute myocardial infarction with aVR leads to poor prognosis in patients with ST segment elevation, and the poor prognosis is associated with severe coronary artery disease. Early intervention in these patients may have important benefits .