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目的:通过冠状动脉(冠脉)内导丝记录冠脉远端单极心电图,探讨冠脉内心电图ST段改变与冠脉成形术后心肌损伤的相关性。方法:选择198例冠心病患者进行单支病变择期PCI治疗,通过冠脉内导丝记录冠脉介入(PCI)术前及最后一次球囊扩张后2min的冠脉远端单极心电图。冠脉内心电图ST段改变≥1mm认为有意义。测定基础水平和术后8h和24h肌钙蛋白T含量。结果:冠脉内心电图ST段改变预测心肌损伤的敏感度为72%,特异度为95%,阳性预测值和阴性预测值分别为90%、84%,准确度为86%。通过(32±4)个月的中期随访发现,冠脉内心电图异常患者术后胸痛和心力衰竭发生率增高,再住院率增加。结论:成功的单支血管PCI术后冠脉内心电图改变,可以为PCI术中发生的心肌损伤提供快速而廉价的识别手段。
OBJECTIVE: To record the distal coronary mononuclear electrocardiogram (ECG) through the guide wire of coronary artery (coronary artery) to investigate the relationship between the change of ST segment in coronary artery and myocardial injury after coronary angioplasty. Methods: A total of 198 patients with coronary artery disease undergoing elective PCI were enrolled in this study. Coronary distal monopolar ECG was recorded before coronary intervention (PCI) and 2 minutes after the last balloon dilation by means of intracoronary guide wire. Coronary ECG ST segment changes ≥ 1mm that makes sense. The basal level and the levels of troponin T at 8h and 24h after operation were measured. Results: The sensitivity and specificity of ST segment changes of coronary artery electrocardiogram in predicting myocardial injury were 72% and 95% respectively. The positive predictive value and negative predictive value were 90%, 84%, respectively. The accuracy was 86%. Through (32 ± 4) months of follow-up found that patients with abnormal intracoronary ECG abnormalities increased postoperative chest pain and heart failure, rehospitalization rate increased. CONCLUSIONS: The successful change of intracoronary ECG after single-vessel PCI can provide a fast and inexpensive method for identifying myocardial damage during PCI.