Wu Yue-E, Ma Lan, Hu Ze-Ping
Department of Electrocardiogram Diagnosis, The Second Affiliated Hospital, Anhui Medical University, Hefei, 230060, Anhui, China.
Department of Cardiology, The First Affiliated Hospital, Anhui Medical University, Hefei, 230022, Anhui, China.
Heart Vessels. 2022 Apr;37(4):539-548. doi: 10.1007/s00380-021-01950-8. Epub 2021 Oct 2.
Tpeak-Tend/QT ratio (Tp-e/QT) in patients with ST-segment elevation myocardial infarction (STEMI) is reportedly associated with major adverse cardiac events (MACEs). However, Tp-e/QT measurement methods are controversial, and few studies have clarified the effect of different Tp-e/QT measures on prognosis. Our study is the first to investigate the advantages of the Tp-e/QT measured by infarct-related-lead method in predicting MACEs during hospitalization and long-term mortality in patients with STEMI. A total of 427 STEMI patients undergoing primary percutaneous coronary intervention (PCI) were included in this study. The Tp-e/QT before PCI was measured by traditional 12-lead method and infarct-related-lead method. Outcomes were tested using comparative statistics, logistic regression, receiver operating characteristic (ROC) curve and Kaplan-Meier survival analysis. There were 62 (14.5%) patients who had MACEs in-hospital. Logistic regression showed that the Tp-e/QT in infarct-related-lead was an independent predictor (p < 0.001). The area under the ROC curve (AUC) of the Tp-e/QT in infarct-related-lead was larger than that in the Tp-e/QT in traditional 12-lead (0.889 vs 0.741), and the optimal cutoff value was 0.32. The three-year survival rate of patients in the infarct-related-lead Tp-e/QT < 0.32 group was better than Tp-e/QT ≥ 0.32 group in Kaplan-Meier survival analysis (93.9 vs 87.0%). When stratified according to infarct-related arteries, the results showed that the common odds ratio of patients in Tp-e/QT ≥ 0.32 group occurred MACEs was 1.562, P = 0.038. The infarct-related-lead Tp-e/QT performed better than the traditional 12-lead Tp-e/QT in predicting poor prognosis.
据报道，ST段抬高型心肌梗死（STEMI）患者的Tpeak-Tend/QT比值（Tp-e/QT）与主要不良心脏事件（MACE）相关。然而，Tp-e/QT的测量方法存在争议，很少有研究阐明不同的Tp-e/QT测量方法对预后的影响。我们的研究首次探讨了梗死相关导联法测量的Tp-e/QT在预测STEMI患者住院期间MACE和长期死亡率方面的优势。本研究共纳入427例行直接经皮冠状动脉介入治疗（PCI）的STEMI患者。PCI术前通过传统12导联法和梗死相关导联法测量Tp-e/QT。采用比较统计学、逻辑回归、受试者工作特征（ROC）曲线和Kaplan-Meier生存分析对结果进行检验。有62例（14.5%）患者在住院期间发生MACE。逻辑回归显示，梗死相关导联的Tp-e/QT是独立预测因子（p<0.001）。梗死相关导联Tp-e/QT的ROC曲线下面积（AUC）大于传统12导联Tp-e/QT的ROC曲线下面积（0.889对0.741），最佳截断值为0.32。在Kaplan-Meier生存分析中，梗死相关导联Tp-e/QT<0.32组患者的三年生存率优于Tp-e/QT≥0.32组（93.9%对87.0%）。按梗死相关动脉分层时，结果显示Tp-e/QT≥0.32组患者发生MACE的共同比值比为1.562，P=0.038。梗死相关导联Tp-e/QT在预测不良预后方面比传统12导联Tp-e/QT表现更好。
