Value of grade Ⅲ ischemia on prediction of shock after primary percutaneous coronary intervention for acute ST-segment elevation myocardial infarction / 中国医师进修杂志

ABSTRACT

Objective To analyze the ischemia degree of initial electrocardiogram in the patients of acute ST-segment elevation myocardial infarction (STEMI) and investigate its value in the predicting cardiogenic shock (CS) after percutaneous coronary intervention (PCI).Methods Three hundred and ninety patients with STEMI from the onset of symptoms to admission within 12 h were divided into two groups based on grade Ⅱ ischemia (group A,248 cases) or grade Ⅲ ischemia (group B,142 cases) in the initial electrocardiogram.Clinical data,TIMI risk score,ST-segment resolution (STR),CS and cardiovascular events (hospital mortality,ventricular arrhythmias,reinfarction) were recorded in all patients.Results The gender,time from onset to balloon opening,smoking,hypertension,type 2 diabetes,hyperlipidemia,stroke,postoperative TIMI flow 3 grade,coronary artery lesions and lesions in the left main stem between two groups was not statistically significant (P ＞0.05).In group B,the rate of ST segment resolution ＞ 50％ was significantly lower than that in group A [53.2％ (132/248) vs.29.6％ (42/142)] (P ＜ 0.01).The incidence of CS,in-hospital death,malignant ventricular arrhythmias in group B was higher than that in group A,and the difference was statistically significant (P ＜ 0.05).The age,left ventricular ejection fraction,TIMI risk score ＞ 3 points,Killip grade ＞ 1 grade,anterior myocardial infarction between two groups was statistically significant (P ＜ 0.05 or ＜ 0.01).The indicators that were statistically significant in the univariate analysis were included into Logistic regression model and analyzed,with CS-related factors as independent variables and CS as the dependent variable and found that age (P =0.008),Killip class ＞ 1 grade (P =0.049),ST segment resolution rate (P =0.008) and grade Ⅲ ischemia (P =0.001) as independent predictors of CS after PCI.Conclusions Grade Ⅲ ischemia is an independent predictor of CS after PCI in STEMI patients.And it has predictive value for hospital mortality and ventricular arrhythmias.