Kazemi Babak, Hajizadeh Reza, Ranjbar Abdolmohammad, Sohrabi Bahram, Vaezi Hasanali
Department of Cardiology, Faculty of Medicine, Tabriz University of Medical Science, Tabriz, Iran.
Department of Cardiology, Faculty of Medicine, Urmia University of Medical Science, Urmia, Iran.
J Electrocardiol. 2020 Jan-Feb;58:160-164. doi: 10.1016/j.jelectrocard.2019.12.001. Epub 2019 Dec 20.
The patients with ST-segment Elevation Myocardial Infarction (STEMI) are significantly at increased risk of arrhythmia. Repolarization of myocardium has been evaluated by a series of electrical parameters including T wave peak to T wave end (Tp-Te) and Tp-Te/QT ratio. Which were compared with survival outcomes between two groups of STEMI patients treated with Primary Percutaneous Coronary Intervention (PPCI) and recombinant Tissue Plasminogen Activator (r-TPA).
In this prospective study, 188 patients with STEMI were included in the study. 12‑Lead ECGs were obtained from all patients on time of admission and after 24 h after treatment. After dividing the patients into two groups based on their type of treatment (PPCI or r-TPA), The Tp-Te/QT and Tp-Te/QTc ratios were calculated using ECG records. The survival outcomes were compared between two groups.
95 patients (50.5%) underwent PPCI and 93 patients (49.5%) received r-TPA. Tp-Te/QT and Tp-Te/QTc ratios after administration of the treatments were significantly decreased in both groups (P-value = .001) with lower Tp-Te/QT and Tp-Te/QTc ratios in PPCI group (P-value = .001). 7 patients in PPCI group (7.3%) and 16 patients in r-TPA group (17.2%) were died during their hospitalization period (P-value = .04). The best combination of sensitivity and specificity of post treatment Tp-Te/QT ratio was at cutoff points of 29.4 with 82% sensitivity and 83% specificity.
Our study demonstrated that Tp-Te/QT and Tp-Te/QTc ratios decrease significantly after both PPCI and r-TPA therapies, but with PPCI these indexes decrease more than r-TPA, resulting a better survival outcome in patients with STEMI.
ST段抬高型心肌梗死（STEMI）患者发生心律失常的风险显著增加。心肌复极化已通过一系列电参数进行评估，包括T波峰至T波终点（Tp-Te）和Tp-Te/QT比值。将这些参数与接受直接经皮冠状动脉介入治疗（PPCI）和重组组织型纤溶酶原激活剂（r-TPA）治疗的两组STEMI患者的生存结局进行比较。
在这项前瞻性研究中，188例STEMI患者被纳入研究。所有患者在入院时和治疗后24小时均按时进行了12导联心电图检查。根据治疗类型（PPCI或r-TPA）将患者分为两组后，使用心电图记录计算Tp-Te/QT和Tp-Te/QTc比值。比较两组的生存结局。
95例患者（50.5%）接受了PPCI，93例患者（49.5%）接受了r-TPA。两组治疗后Tp-Te/QT和Tp-Te/QTc比值均显著降低（P值=0.001），PPCI组的Tp-Te/QT和Tp-Te/QTc比值更低（P值=0.001）。PPCI组7例患者（7.3%）和r-TPA组16例患者（17.2%）在住院期间死亡（P值=0.04）。治疗后Tp-Te/QT比值的敏感性和特异性的最佳组合在截断点为29.4时，敏感性为82%，特异性为83%。
我们的研究表明，PPCI和r-TPA治疗后Tp-Te/QT和Tp-Te/QTc比值均显著降低，但PPCI治疗后这些指标的降低幅度大于r-TPA，从而使STEMI患者的生存结局更好。
