Mann Tomer, Moses Amit, Yesaulov Anastasiea, Hochstadt Aviram, Granot Yoav, Rosso Raphael, Shacham Yacov, Chorin Ehud
Department of Cardiology, Tel Aviv Sourasky Medical Center and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
Front Cardiovasc Med. 2023 Jan 6;9:1056456. doi: 10.3389/fcvm.2022.1056456. eCollection 2022.
An association between excessively prolonged QT and ventricular arrhythmia in patients with ST-elevation myocardial infarction has been described; however, the QT dynamics, characterization, and long-term predictive value are not well known.
To characterize QT interval dynamics in patients undergoing ST elevation myocardial infarction (STEMI) and determine its association with mortality.
A retrospective analysis of 4,936 consecutive patients, hospitalized for STEMI between 01/2013-12/2021. Patients with less than three electrocardiograms (ECGs) during index hospitalization were excluded. Baseline demographics, cardiovascular history, clinical risk factors, treatment measures, laboratory results, and mortality data were retrieved from the hospital's electronic medical records.
We included 1,054 patients and 5,021 ECGs in our cohort with a median follow-up of 6 years [interquartile range (IQR) 4.3-7.4 years]. The QT was longer in women in comparison to men (428.6 ms ± 33.4 versus 419.8 ms ± 32.52, -value = 0.001). QT prolongation was greater in females, elderly patients, and patients with STEMI caused by occlusion of the left anterior descending (LAD) coronary artery. We determined QT cutoff to be 445 ms. This value of QT divided our cohort upon arrival into a long QT group (217 patients, 26% of the cohort) and a "normal" QT group (835 patients, 74% of the cohort). The long QT group experienced an increase in combined short and long terms all-cause mortality. The QT upon arrival, on day 2 of hospitalization, and before discharge from the hospital, correlated with long-term mortality.
QT duration is often prolonged during STEMI; this prolongation is associated with increased mortality and adverse events. Gender is an important mediator of QT dynamics.
已有研究表明，ST段抬高型心肌梗死患者中，QT间期过度延长与室性心律失常之间存在关联；然而，QT间期的动态变化、特征及长期预测价值尚不明确。
描述ST段抬高型心肌梗死（STEMI）患者的QT间期动态变化，并确定其与死亡率的关联。
对2013年1月至2021年12月期间因STEMI住院的4936例连续患者进行回顾性分析。排除在索引住院期间心电图（ECG）少于三次的患者。从医院电子病历中获取基线人口统计学、心血管病史、临床危险因素、治疗措施、实验室检查结果及死亡率数据。
我们的队列纳入了1054例患者和5021份ECG，中位随访时间为6年[四分位间距（IQR）4.3 - 7.4年]。女性的QT间期长于男性（428.6毫秒±33.4对419.8毫秒±32.52，P值 = 0.001）。女性、老年患者以及由左前降支（LAD）冠状动脉闭塞引起的STEMI患者QT间期延长更明显。我们确定QT间期临界值为445毫秒。根据该QT值，将我们的队列在入院时分为长QT组（217例患者，占队列的26%）和“正常”QT组（835例患者，占队列的74%）。长QT组短期和长期全因死亡率均升高。入院时、住院第2天及出院前的QT间期与长期死亡率相关。
STEMI期间QT间期常延长；这种延长与死亡率增加及不良事件相关。性别是QT间期动态变化的重要调节因素。
