Relationship Between Tp-Te,Tp-e/QT Ratio And ST Segment Recovery In The STEMI Patients After PPCI And Its Effect On The Arrhythmia

Objective Aim to investigate the relationship between Tpec?Tp-Te / QT ratio with the ST-segment resolution in patients who are ST segment elevated myocardial infarction(STEMI)with successful revascularization by primary PCI,And analysis the effect of Tpec?Tp-Te / QT ratio on the ventricular tachycardia,Last analysis the variety of clinical factors related to arrhythmia.Methods A total of 1340 patients with STEMI were enrolled in the First Hospital of Lanzhou University from September 2014 to December 2016 were included.Both had been successful revascularization by primary PCI.206 patients were selected according to the inclusion and exclusion criteria.According to intraoperative angiography,Record all the degrees and ranges of coronary artery stenosis.All patients were divided into single vessel disease group(85 cases)and multivessel disease group(121 cases).The heart rate,RR interval,QT interval,ST-segment elevation of all infarct-related lead were recorded.The patients were divided into two groups according to the ST segment recovery after 2 h postoperatively.STR ? 50% group(163 cases)and STR <50% group(43 cases).Record the 24 dynamic electrocardiogram during hospital and divided into two groups according to Lown stratification,the Lown grade?3 are divided into the MVA group(35cases)and <3 divided into the non-MVA group(171cases).Measuring the T-wave peak to the end in the infarct-related lead of all the patients before and after PPCI postoperatively,According to the Bazett formula,Tpec is defined by the Bazett formula Tp-Te [Tpec = Tp-Te /(RR)1/2).The age,sex,history of hypertension,diabetes mellitus,smoke,blood glucose,blood lipids,left ventricular ejection fraction,and other clinical baseline data were recorded.Statistical analysis was performed with SPSS 21.0 software,Analyze the difference between two groups using t test,the count data using chi-square test,The relationship between two variables was analyzed by bivariate regression,Logistic regression analyses was performed to analysis the clinical factors related to the MVA event,The effect of different lesions on the Tp-Te?Tp-Te / QT raio was analyzed by ANOVA variance analysis,and the chi-square test was used to compare the rate,At last drawn the ROC curve of MVA event.Result The effects of STR on the Tpec and Tp-Te / QT after PPCI: the Tp-ec?Tp-e/QT of the two groups before PPCI are(119 ± 15.7ms VS115 ± 13.9ms),(0.32± 0.04VS0.31 ± 0.05),P> 0.05,the difference have not statistically significant.The Tpec?Tp-Te / QT of the two groups were significantly decreased after 2 hours of PPCI,But the STR ? 50% group decreased significantly great than the other group.Which the Tpec(110±16.0 ms V101±13.1 ms p = 0.01),Tp-Te / QT(0.28 ± 0.05VS0.24 ± 0.04 P <0.001),The p values both less than 0.05.The comparison of the Tpec,Tp-Te / QT,heart rate between the MVA group and the non-MVA group: The Tpec and Tp-Te / QT of the MVA group before PPCI were significantly higher than those in the non-MVA group(125 ± 16.4 ms VS114 ±13.1ms p <0.001),(0.33 ± 0.05VS0.29 ± 0.04 p <0.001),the difference have statistically significant.There were still have significant differences between the two groups of the Tpec and Tp-Te / QT after 2 hours of PPCI,with P <0.05.Analysis the diagnostic Value of Tpec,Tp-Te / QT in the Postoperative MVA Events: According to the postoperative MVA event,Drawn the ROC curve and get the optimal cutoff of the Tpec and Tp-Te / QT.The preoperative Tpec is 118 ms,Which the sensitivity in diagnosis of arrhythmia was 88.6%,the specificity was 59.6%,the positive predictive value was 68.57%,the negative predictive value was 32.75%;the preoperative Tp-Te / QT is 0.30,the sensitivity was 77.1%,the specificity was 73.2% The predicted value was 80.0% and the negative predictive value was 42.11%.The risk of developing MVA event in patients with Tp-ec ?118 ms is 2.18 times than that of Tp-ec <118 ms,and the risk of developing MVA in patients with Tp-e / QT?0.30 is four times than that of Tp-e / QT 0.30 patients.The differents have Statistical significance,suggesting that Tpec ? 118 ms,Tp-Te / QT ? 0.30 have a high diagnostic value in the prediction of MVA events,but the latter's has a higher diagnostic value.Analysis of the clinical factors related to the MVA event : There have no significant correlation between MVA events with age,sex,BMI,hypertension,diabetes mellitus,blood glucose,lipid and left ventricular systolic function,But the Tpec interval,Tp-Te / QT ratio both are the independent predictors of MVA events before or after PPCI,The OR of STR is less than 1(P <0.05),is the protection factors of reduce the MVA event.Conclusion 1.The better the ST segment recovery after 2 hours of PPCI,the smaller of the Postoperative Tpec and the Postoperative Tp-Te / QT.2.The Tpec?Tp-Te / QT in the MVA group were significantly higher than those in the non-MVA group before or after PPCI,suggesting that the Tpec and Tp-Te / QT were the risk factors of the MVA events and STR ? 50% is the protection factor.3.the Tpec ? 118 ms,Tp-Te / QT ? 0.30 before PPCI had a higher diagnostic value in predicting the postoperative MVA event,but the diagnostic value of Tp-Te / QT?0.30 was higher,the greater the ratio,the higher of the incidence of MVA event.