Study Of ST-segment Elevation And Tpeak-Tend/QT Interval In Predicting The Occurrence Of Major Adverse Cardiac Events In ST-segment Elevation Myocardial Infarction Patients Undergoing Percutaneous Coronary Intervention

Background and Purpose:The occurrence of major adverse cardiovascular events(MACE)is the main cause of death in patients with ST-segment elevation myocardial infarction(STEMI),which seriously affects the effectiveness of interventional therapy and the prognosis of patients.How to identify and predict the occurrence of MACE events in STEMI patients early,and then intervene in time,has a positive significance for guiding clinical treatment and improving patient prognosis.Among the parameters related to ECG,the elevation of ST segment indicates the possibility of transmural myocardial ischemia caused by the occlusion of epicardial great vessels,which often indicates that the condition is critical and the prognosis is poor.At present,the main goal of saving the necrotic myocardium is to open the target vessel of the disease,restore the myocardial blood flow and improve the circulation.The resolution of ST segment on ECG is often used as the evidence of ECG to evaluate the recovery of myocardial blood supply after acute myocardial infarction and reperfusion.The degree of ST segment resolution can be used as an important index to evaluate myocardial effective perfusion,and poor ST segment resolution will lead to poor prognosis.The Tp-e interval represents the dispersion of transventricular wall repolarization.The QT interval represents the time course of ventricular repolarization,and QTd reflects the spatial dispersion of ventricular repolarization and is an indicator for predicting the occurrence of arrhythmia.Tp-e is a component of the QT interval,but it is more effective than the QT interval to reflect dispersion.Tp-e/QT is a more sensitive indicator of arrhythmia prediction than Tp-e,and it is obviously related to the occurrence of malignant arrhythmia,and it is an important early warning indicator of the possibility of sudden cardiac death.A large number of studies have clarified that the electrocardiogram parameters such as Tp-e interval,Tp-e/QT ratio have clear predictive value for the occurrence of malignant arrhythmia events in long QT interval syndrome and short QT Intermittent syndrome,Brugada syndrome,Variant angina,early repolarization syndrome,heart failure,hypertrophic cardiomyopathy and other disease models.However,there is little report on the predictive value of ST segment elevation after PCI and other ECG parameters on the occurrence of MACE events.This study explored the predictive value of these parameters for MACE through the calculation and statistical analysis of ECG parameters such as the degree of postoperative ST segment elevation(STE),Tp-e interval,Tp-e/QT ratio in STEMI patients.Methods:A retrospective analysis of 254 STEMI patients who were admitted to Henan University People's Hospital for acute chest pain and successfully received PCI treatment was divided into the MACE group(24 cases)and the MACE-free group(230 cases)according to the incidence of MACE within 1year after surgery.Independent sample t test,X2 test,univariate and multivariate logistic regression analysis and receiver operating characteristic curve(ROC)were used to analyze the correlation among ECG parameters and their predictive value of MACE events including cardiac death and malignant arrhythmia(ventricular tachycardia/ ventricular fibrillation,syncope,and sudden resuscitation of sudden cardiac death).Result:1.Baseline characteristics: There is no significant difference between the MACE group and the MACE-free group in terms of age,gender,and risk factors for cardiovascular disease(such as hypertension,diabetes,dyslipidemia,and smoking),criminal blood vessels,and the time from the onset of symptoms to revascularization(P> 0.05).2.The MACE group has a higher STE [(98.63 ± 25.56)?V:(64.33 ± 16.92)?V,P <0.001],longer corrected QT interval dispersion [c QTd,(48.13 ± 5.33)ms:(44.41 ± 10.3)ms,P <0.001],longer corrected Tp-e interval [c Tp-e,(163.25 ± 31.60)ms:(127.51 ± 13.87)ms,P <0.001] Larger Tp-e/QT ratio(0.40 ± 0.08 vs 0.31 ± 0.04,P <0.001).3.Single factor regression analysis shows c QTd(Odds ratio(OR)= 1.621,95%Confidence intervals(CI): 1.042 ~ 2.522,P = 0.032),c Tp-e(OR = 6.186,95% CI: 3.257 ~ 11.747,P <0.01),Tp-e/QT ratio(OR = 4.931,95% CI: 2.788 ~ 8.721,P <0.01),STE(OR = 6.165,95% CI: 3.385 ~ 11.228,P <0.01)are all related to the occurrence of MACE.Multivariate binary logistic regression analysis shows that both STE and Tp-e/QT ratio entered the regression equation,and both were independent predictors of MACE.4.The correlation analysis between STE and c Tp-e interval,STE and Tp-e/QT ratio,Tp-e/QT ratio and c Tp-e shows that the correlation coefficients are 0.829(P <0.01)and 0.636(P <0.01),0.733(P <0.01),indicating that STE,c Tp-e interval and Tp-e/QT may have a mechanism correlation.The area under the ROC curve(AUC)of c QTd,c Tp-e,Tp-e / QT and STE were 0.663,0.831,0.818,and 0.861,respectively.The combined predicted AUC of STE and Tp-e/QT ratio is 0.909.The Z test of Med Calc software shows that there is no significant difference between AUC of STE and Tp-e/QT ratio,there is a significant difference between the two and c QTd AUC(P <0.05),and there is no significant difference between the two and c Tp-e AUC(P> 0.05).Conclusion:STE,c Tp-e interval and Tp-e/QT ration have certain predictive value for the occurrence of MACE in the STEMI patient model.In witch STE and Tp-e/QT are independent predictors of MACE occurrence in STEMI patients after PCI,and they may have a mechanism correlation.