Abdelmegid Mohamed Aboel-Kassem F, Bakr Mohamed M, Shams-Eddin Hamdy, Youssef Amr A, Abdel-Galeel Ahmed
Department of Cardiovascular Medicine, Assiut University Heart Hospital, Assiut University, Assiut 71526, Egypt.
Department of Cardiology, Sohag Heart and GIT Center, Sohag 85264, Egypt.
World J Cardiol. 2023 Mar 26;15(3):106-115. doi: 10.4330/wjc.v15.i3.106.
Myocardial ischemia and ST-elevation myocardial infarction (STEMI) increase QT dispersion (QTD) and corrected QT dispersion (QTcD), and are also associated with ventricular arrhythmia.
To evaluate the effects of reperfusion strategy [primary percutaneous coronary intervention (PPCI) or fibrinolytic therapy] on QTD and QTcD in STEMI patients and assess the impact of the chosen strategy on the occurrence of in-hospital arrhythmia.
This prospective, observational, multicenter study included 240 patients admitted with STEMI who were treated with either PPCI (group I) or fibrinolytic therapy (group II). QTD and QTcD were measured on admission and 24 hr after reperfusion, and patients were observed to detect in-hospital arrhythmia.
There were significant reductions in QTD and QTcD from admission to 24 hr in both group I and group II patients. QTD and QTcD were found to be shorter in group I patients at 24 hr than those in group II (53 ± 19 msec 60 ± 18 msec, 0.005 and 60 ± 21 msec 69+22 msec, 0.003, respectively). The occurrence of in-hospital arrhythmia was significantly more frequent in group II than in group I (25 patients, 20.8% 8 patients, 6.7%, 0.001). Furthermore, QTD and QTcD were higher in patients with in-hospital arrhythmia than those without ( 0.001 and 0.02, respectively).
In STEMI patients, PPCI and fibrinolytic therapy effectively reduced QTD and QTcD, with a higher observed reduction using PPCI. PPCI was associated with a lower incidence of in-hospital arrhythmia than fibrinolytic therapy. In addition, QTD and QTcD were shorter in patients not experiencing in-hospital arrhythmia than those with arrhythmia.
心肌缺血和ST段抬高型心肌梗死（STEMI）会增加QT离散度（QTD）和校正QT离散度（QTcD），且与室性心律失常相关。
评估再灌注策略[直接经皮冠状动脉介入治疗（PPCI）或溶栓治疗]对STEMI患者QTD和QTcD的影响，并评估所选策略对院内心律失常发生情况的影响。
这项前瞻性、观察性、多中心研究纳入了240例因STEMI入院的患者，这些患者接受了PPCI治疗（I组）或溶栓治疗（II组）。在入院时和再灌注后24小时测量QTD和QTcD，并观察患者以检测院内心律失常。
I组和II组患者从入院到24小时，QTD和QTcD均显著降低。发现I组患者在24小时时的QTD和QTcD比II组短（分别为53±19毫秒对60±18毫秒，P=0.005；60±21毫秒对69±22毫秒，P=0.003）。II组院内心律失常的发生率显著高于I组（25例患者，20.8%对8例患者，6.7%，P=0.001）。此外，发生院内心律失常的患者的QTD和QTcD高于未发生心律失常的患者（分别为P<0.001和P=0.02）。
在STEMI患者中，PPCI和溶栓治疗均有效降低了QTD和QTcD，PPCI观察到的降低幅度更高。与溶栓治疗相比，PPCI与较低的院内心律失常发生率相关。此外，未发生院内心律失常的患者的QTD和QTcD比发生心律失常的患者短。
