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目的:探讨非ST段抬高型急性冠脉综合征(NSTE-ACS)患者心电图a VR导联ST段抬高与近期预后的相关性。方法:将195例NSTE-ACS患者按照入院时a VR导联ST段是否抬高分为ST段抬高组和非ST段抬高组;记录两组患者的一般临床资料、实验室相关检查指标、冠脉病变情况以及住院期间是否发生主要不良心脏时间(MACE)等情况。结果:与非ST段抬高组比较,ST段抬高组患者心率较快、收缩压及舒张压较高,Killip分级≥2的比例亦较高(P<0.05);ST段抬高组患者血清hs-CRP、NT-pro BNP、c Tn I、CK-MB高于对应组(P<0.05),LVEF低于对应组;a VR导联以外ST段压低总例数及幅度亦高于非ST段抬高组(P<0.05);ST段抬高组患者中冠脉三支病变以及左主干的比例高于非ST段抬高组(P<0.05);与非MECE组比较,MECE组中入院AVR导联ST段抬高的比例及抬高的幅度较高(P<0.05);心率、NT-pro BNP、c Tn I、冠脉左主干及三支病变与NSTE-ACS患者入院时a VR导联ST段抬高呈正相关(P<0.05),而LVEF与其呈负相关(P<0.05);a VR导联ST段抬高是NSTE-ACS患者近期发生MACE的高危因素。结论:心电图a VR导联ST段抬高与严重广泛的冠脉病变及大面积心肌缺血有密切关系,可能是NSTE-ACS患者近期预后的独立危险因素。
Objective: To investigate the correlation between the ST segment elevation of electrocardiogram (VR) lead and short-term prognosis in patients with non-ST segment elevation acute coronary syndrome (NSTE-ACS). Methods: One hundred and nineteen patients with NSTE-ACS were divided into ST-segment elevation and non-ST-segment elevation according to whether the ST segment elevation of a VR lead on admission. The clinical data of two groups were recorded. The related laboratory indexes , Coronary artery disease and hospitalization during the occurrence of major adverse cardiac time (MACE) and so on. Results: Compared with non-ST elevation group, ST elevation group had faster heart rate, higher systolic and diastolic blood pressure, and higher Killip grade ≥2 (P <0.05). ST-segment elevation patients The serum levels of hs-CRP, NT-pro BNP, cTn I and CK-MB were higher than those of the corresponding group (P <0.05), and LVEF was lower than that of the corresponding group ST-segment elevation group (P <0.05). The ratio of coronary artery lesion and left main trunk in ST-segment elevation group was higher than that in non-ST-segment elevation group (P <0.05) The percentage of ST-segment elevation and elevation in AVR leads were higher (P <0.05). Heart rate, NT-pro BNP, cTn I, left main coronary artery, three-vessel disease and NSTE-ACS patients (P <0.05), while LVEF was negatively correlated with ST segment elevation (P <0.05). The ST segment elevation of a VR lead was a high risk factor of recent MACE in patients with NSTE-ACS. Conclusion: ST segment elevation in VR lead of ECG is closely related to severe and extensive coronary artery disease and myocardial ischemia. It may be an independent risk factor for the short-term prognosis of patients with NSTE-ACS.