Tsai Tzu-Hsien, Sun Cheuk-Kwan, Chung Wen-Jung, Lin Yu-Chun, Leu Steve, Hussein Hesham, Chen Yung-Lung, Chung Sheng-Ying, Chai Han-Tan, Chua Sarah, Fu Morgan, Yip Hon-Kan
Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Chang Gung University College of Medicine, Kaoshiung, Taiwan.
Int Heart J. 2010;51(5):325-30. doi: 10.1536/ihj.51.325.
The prognostic value of integrated R-wave voltages of precordial leads (V(1)-V(6)) in patients with acute anterior wall ST-elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI) was investigated. Between July 2006 and October 2009, 292 patients with anterior wall STEMI with presentation < 12 hours underwent primary PCI. Thirty-four patients with electrocardiographic presentation of either complete right bundle branch block (BBB) or complete left BBB were categorized into group A, while the remaining 258 patients without BBB served as group B that was further subdivided into those with lower R-wave voltage (summation of V(1)-V(6) ≤ 1.7 mV) (group 1) and higher voltage (> 1.7 mV) (group 2) according to the ROC curve (sensitivity = 66.3%, specificity = 66%, P < 0.0001).While the procedural success rate was similar between groups A and B and groups 1 and 2, 30-day mortality was higher in group A than B (P ≤ 0.0001). Additionally, left ventricular ejection fraction (LVEF) was lower, whereas peak level of creatine phosphokinase (CPK), incidence of advanced congestive heart failure, and 30-day mortality were higher in group 1 than 2 (P < 0.01). Multivariate analysis revealed that lower R-wave voltage, multivessel disease, leukocyte count, peak CPK, and creatinine level were predictive of 30-day unfavorable clinical outcomes (all P < 0.01). R-wave voltage in precordial leads was a significant independent predictor of 30-day prognostic outcome in patients with anterior wall STEMI undergoing primary PCI.
研究了急性前壁ST段抬高型心肌梗死（STEMI）患者在接受直接经皮冠状动脉介入治疗（PCI）时胸前导联（V(1)-V(6)）R波综合电压的预后价值。2006年7月至2009年10月，292例发病时间<12小时的前壁STEMI患者接受了直接PCI。34例心电图表现为完全性右束支传导阻滞（BBB）或完全性左束支传导阻滞的患者被归入A组，其余258例无BBB的患者作为B组，根据ROC曲线（敏感性=66.3%，特异性=66%，P<0.0001），B组进一步分为R波电压较低（V(1)-V(6)总和≤1.7mV）的患者（1组）和电压较高（>1.7mV）的患者（2组）。虽然A组与B组以及1组与2组之间的手术成功率相似，但A组的30天死亡率高于B组（P≤0.0001）。此外，1组的左心室射血分数（LVEF）较低，而肌酸磷酸激酶（CPK）峰值水平、晚期充血性心力衰竭发生率和30天死亡率均高于2组（P<0.01）。多变量分析显示，R波电压较低、多支血管病变、白细胞计数、CPK峰值和肌酐水平可预测30天不良临床结局（所有P<0.01）。胸前导联R波电压是接受直接PCI的前壁STEMI患者30天预后结局的重要独立预测因素。
