The Application Of Early Repolarization On Admission Electrocardiography In Forecasting Mortality Risk Of Acute Anterior Myocardial Infarction

Background:Early repolarization(ER) was used to be considered as a single of health. Until recent years, it had be found that be associated with sudden cardiac death(SCD) and idiopathic ventricular tachycardia or ventricular fibrillation, increase mortality. Therefore, now ERP have been a research focus in angiocardiopathy cardiovascular disease area at home and abroad. Now both overseas and Chinese researchers studied such fields as the relationship of ER and SCD?the pathogenetic mechanism of serious ventricular arrhythmia?particularly ioniccurrent mechanism?predictive of SCD caused by ER?the treatment of ER and the prevention of SCD caused by ER. Though those researches, it have been verified that ERP unite the amplitude of J-wave and the range of ST-segment. But in different population the predictive value of ER in sudden death risk is still need in-depth study, especially the death risk prediction in AMI particularly anterior AMI patients have many unsolved question need to study.Part One. The Retrospective Cohort Study of Early Repolarization on admission electrocardiography predict the death risk of acute anteriormyocardial infarctionObjective:In recent years, many studies showed that early repolarization on admission electrocardiography is associated with SCD and IVT/IVF, increase mortality. Study of ERP and AMI patient is rarely be report, so, we retrospective analyzed AMI patients admitted to our hospital from 2009 until 2013, to evaluate the character of ERP in patients with AMI, provide foundation of our next prospective study.Methods:This study population consisted of 433 AMI patients admitted to PLA hospital from 2009 to 2013. Those patients selected for this study received coronary angiogram during the index hospitalization. Infarct locations were classified as anterior based on angiographic findings,excepting patients with right coronary artery or posterior completely blocked. According to the clinical electrocardiogram data, we set positive(ER+) and negative (ER-) groups to study the morbidity of ventricular tachycardia or ventricular fibrillation.Results:(1)54.88%ER patients with terminal QRS characterized as notching,39.09%ER patients with terminal QRS characterized as slurring,only each 3%ER patients with terminal QRS characterized as notching or slurring and J point elevation. The result shows that most ERP's terminal QRS characterized notching and slurring, especially notching.(2)49.62% ERP located in inferior,37.59% ERP located in inferior andpericardial leads;4.51% ERP located in lateral,8.27% ERP located in lateral and pericardial leads.(3)93.98% ST-segment are horizontal type, only 6% patients'ST-segment are acclivitous type.(4)Compared to control group, the heart rate of ERP patients are slower (67.46±1.72 beats/min, vs.78.36 ±7.09 beats/min, p< 0.01), duration of QRS complex are longer(98.12±6.80ms vs.90.88±8.41ms, p<0.01).(5)The incidence of malignant ventricular arrhythmia have no significant differences (8.27% vs.7%)Conclusions:(1) Most acute anteriormyocardial infarction patients with ERP characterized as terminal QRS notching, always located in inferior or inferior and pericardial leads,most ST-segment are horizontal type.(2)The heart rate of ERP patients are slower,duration of QRS complex are longer.(3)There was no significant increase of malignant ventricular arrhythmia.Part Two.The application of early repolarization on admission electrocardiography in forecasting mortality risk of acute anterior myocardial infarctionObjective:To study the predictive value of ERP in acute anterior myocardial infarction patients'mortality risk.Methods:The study consisted of patients diagnosed as acute anterior myocardial infarction from January 2013 to December 2015. Those patients selected for this study received coronary angiogram during the index hospitalization. Infarct locations were classified as anterior based on angiographic findings, excepting patients with right coronary artery or posterior completely blocked.Results:(1)Compare baseline information of the two group such as age, gender, smoking, LVEF, hypertension, hyperlipidemia, diabetes mellitus, door to ball time and the number of vascular stenosisall have no significant difference.(2)The incidence rate of ventricular tachycardia and ventricular fibrillation shows that the ERP group is higher than the control group(P<0.05).(3) The mortality of ERP group is higher than control group(P<0.05).(4)Notching of the J wave was observed in 49% patients, slurring in 42% patients, notching and slurring mixed in 3% patients and only J point elevated in 4% patients.(5)Patients with the elevation of the J point above 0.2 mV are 18%.(6) The form of ST-segment elevation:4% was acclivitous,96% was horizontal.(7)ERP located in 5% in lateral leads,7% in lateral and pericardialleads,54% in inferior leads,32% in inferior and pericardial leads.(8)The ECG characteristics of the two group comparison:the heart rate is slower(P<0.05), the QRSD is longer (P<0.01), the QTc is shorter(P<0.05), the PR and QT have no significant difference.Conclusion:(1) AMI patients with ERP seem to be at a higher risk for VT/VF.(2) The mortality of AMI patients with ERP is higher.(3)ERP patients have slower heart rate, longer QRSD and shorter corrected QT-interval.