Chávez-González Elibet, Rodríguez-Jiménez Ailed Elena, Ferrer-Rodríguez Carlos Javier, Donoiu Ionut
Electrophysiology Department, Cardiocentro Ernesto Che Guevara, Santa Clara, Cuba.
Cardiology Service, Camilo Cienfuegos Universitary Hospital, Sancti Spíritus, Cuba.
Rev Port Cardiol. 2022 May;41(5):395-404. doi: 10.1016/j.repc.2021.03.015. Epub 2022 Mar 9.
The electrocardiogram continues to be essential in the diagnosis of acute myocardial infarction, and a useful tool in arrhythmic risk stratification. We aimed to determine which electrocardiographic variables can successfully predict the occurrence of ventricular arrhythmias (VA) in patients following ST-segment elevation myocardial infarction (STEMI).
We performed an observational study including 667 patients with STEMI admitted to the University Hospital in Sancti Spíritus, Cuba. Demographic variables, cardiovascular risk factors, and clinical variables were recorded. Electrocardiographic variables included QT interval duration (measured and corrected) and QT dispersion, QRS duration and dispersion, JT interval duration and ST-segment elevation magnitude. We also determined left ventricular ejection fraction and glomerular filtration rate. A binary statistical regression model and a regression tree were used to determine the variables that successfully predicted VA.
VA occurred in 92 (13.8%) patients, within the first 48 hours in 68 (73.9%) and after this period in 24 (26.1%) patients. The variables associated with VA were QT interval duration >529 ms and QT dispersion >66 ms, QRS dispersion >50 ms, and the presence of ST-segment elevation in six or more leads.
The main predictor of VA occurring during the initial 48 hours was QT interval duration, while, after this period, it was QRS dispersion.
心电图在急性心肌梗死的诊断中仍然至关重要，并且是心律失常风险分层的有用工具。我们旨在确定哪些心电图变量能够成功预测ST段抬高型心肌梗死（STEMI）患者室性心律失常（VA）的发生。
我们进行了一项观察性研究，纳入了667例入住古巴圣斯皮里图斯大学医院的STEMI患者。记录了人口统计学变量、心血管危险因素和临床变量。心电图变量包括QT间期时长（测量值及校正值）和QT离散度、QRS波时限和离散度、JT间期时长以及ST段抬高幅度。我们还测定了左心室射血分数和肾小球滤过率。采用二元统计回归模型和回归树来确定成功预测VA的变量。
92例（13.8%）患者发生了VA，其中68例（73.9%）在最初48小时内发生，24例（26.1%）在此之后发生。与VA相关的变量为QT间期时长>529毫秒、QT离散度>66毫秒、QRS离散度>50毫秒以及六个或更多导联出现ST段抬高。
最初48小时内发生VA的主要预测因素是QT间期时长，而在此之后则是QRS离散度。
