Zhao Yangyang, Fang Yini, Zhao Hang, Wang Ai-Ling, Peng Jiecheng
Department of Cardiology, the First People's Hospital of Anqing affiliated to Anhui Medical University, Anqing, China.
The Fifth Clinical College of Anhui Medical University, Hefei, China.
Cardiovasc Diagn Ther. 2024 Jun 30;14(3):388-401. doi: 10.21037/cdt-23-398. Epub 2024 Jun 18.
Previous studies have suggested that adequate myocardial reperfusion after percutaneous coronary intervention (PCI) can improve the inhomogeneity of myocardial repolarization. However, it remains unclear whether no-reflow (NR) following emergency PCI involves disadvantages related to ventricular repolarization indices. The present study aimed to determine the effect of NR on QT dispersion (QTd) in patients with ST-segment elevation myocardial infarction (STEMI) and to evaluate the prognostic value of the relative reduction of QTd on ventricular arrhythmia events (VAEs).
A prospective case-control study was conducted. According to the inclusion criteria, 275 patients with STEMI who underwent primary PCI treatment at the First People's Hospital of Anqing affiliated to Anhui Medical University from January 2020 to May 2023 were enrolled. According to whether NR occurred during PCI, these patients were divided into two groups: an NR group and a non-NR group. Subsequently, the QT intervals were measured before and at 12 hours after PCI. Afterward, the QTd, corrected QTd (QTcd), and the relative reduction of QTd and QTcd 12 hours pre- and postprocedure (ΔQTd-R and ΔQTcd-R, respectively) were calculated. Finally, multivariable logistic regression analysis was performed to predict the risk of VAE occurrence.
In the non-NR group, there was a significant decrease from baseline in postprocedure QTd (48±17 73±22 ms; P=0.009) and QTcd (54±19 80±23 ms; P=0.01); in contrast, the NR group showed no significant difference in QTd (64±20 75±23 ms; P=0.58) or QTd (70±22 82±26 ms; P=0.45). Furthermore, the ΔQTd-R and ΔQTcd-R were both lower in the NR group than in the non-NR group (P<0.05); however, the rate of VAEs was higher in the NR group than in the non-NR group (15.2% 6.2%; P=0.02). The multivariable logistic regression analysis results revealed that each increase of 12% in ΔQTcd-R was an independent predictor of VAEs (odds ratio: 0.547; 95% confidence interval: 0.228-0.976).
The NR phenomenon following primary PCI in patients with STEMI leads to the defective recovery of QTd and QTcd. Furthermore, ΔQTcd-R can be viewed as an effective indicator for evaluating the myocardial repolarization inhomogeneity, and short-term clinical outcomes.
先前的研究表明，经皮冠状动脉介入治疗（PCI）后充分的心肌再灌注可改善心肌复极的不均一性。然而，急诊PCI后无复流（NR）是否与心室复极指标相关的劣势仍不清楚。本研究旨在确定NR对ST段抬高型心肌梗死（STEMI）患者QT离散度（QTd）的影响，并评估QTd相对降低对室性心律失常事件（VAEs）的预后价值。
进行一项前瞻性病例对照研究。根据纳入标准，纳入2020年1月至2023年5月在安徽医科大学附属安庆市第一人民医院接受直接PCI治疗的275例STEMI患者。根据PCI过程中是否发生NR，将这些患者分为两组：NR组和非NR组。随后，在PCI前和PCI后12小时测量QT间期。之后，计算QTd、校正QTd（QTcd）以及PCI前后12小时QTd和QTcd的相对降低值（分别为ΔQTd-R和ΔQTcd-R）。最后，进行多变量逻辑回归分析以预测VAEs发生的风险。
在非NR组中，术后QTd（48±17对73±22 ms；P=0.009）和QTcd（54±19对80±23 ms；P=0.01）较基线有显著降低；相比之下，NR组的QTd（64±20对75±23 ms；P=0.58）或QTcd（70±22对82±26 ms；P=0.45）无显著差异。此外，NR组的ΔQTd-R和ΔQTcd-R均低于非NR组（P<0.05）；然而，NR组的VAEs发生率高于非NR组（1
