| Objective: This study aims to explore the correlation between the upright a VR lead T wave(a VRT+)of the body surface 12-lead electrocardiogram and patients with acute myocardial infarction(AMI),and to further clarify the effect of the a VR lead T wave upright on the hospital and distant patients with acute myocardial infarction.Predictive value of major adverse cardiac events(MACE).Methods: This study is a single-center,retrospective cohort study.A total of 595 AMI patients admitted to the Department of Cardiology,Lanzhou University First Hospital from January 2021 to July 2021 were selected as the research subjects.According to the 12-lead electrocardiogram collected before percutaneous coronary intervention,AMI patients were divided into the a VRT wave inversion(a VRT-)group and the a VRT wave upright group according to whether the T wave in lead a VR was upright.There were 203 patients in the(a VRT+)group.At the same time,the clinical data of the two groups of patients were collected and recorded,including gender,age,type of myocardial infarction,history of diabetes,history of hypertension,history of hyperlipidemia,history of myocardial infarction,history of previous percutaneous coronary intervention(PCI),and history of smoking,related laboratory indicators[serum creatinine,blood glucose,hypersensitive troponin(c TNI),creatine kinase isoenzyme(CK-MB),N-terminal pro-brain natriuretic peptide(NT-pro BNP)],left ventricular ejection Score(LVEF),systolic blood pressure,diastolic blood pressure,door to balloon time(D2B),onset to balloon time(symptom onset-to-ballon,S2B),lesion site(anterior wall,posterior wall,inferior wall,lateral wall),intraoperative conditions(multiple infarction,reflow after PCI),number of diseased vessels,and hospital stay;the incidence of MACE in the hospital,including cardiac death,was recorded in the two groups of patients,cardiogenic shock,and ventricular arrhythmia;and through a 1-year follow-up of the discharged patients,the incidence of MACE in the two groups within 1 year was recorded,including cardiac death,heart failure,and recurrent angina.According to the univariate analysis of relevant clinical items according to the outcome of MACE in the hospital and MACE within 1 year,the difference between the groups was obtained;Receiver operating characteristic(ROC)curve analysis was used to evaluate the diagnostic efficacy of T wave changes in a VR lead on the occurrence of in-hospital and long-term composite endpoint events.Results:(1)Compared with the a VR lead T wave inversion group,the sex,myocardial infarction type,diabetes history,hypertension history,and hyperlipidemia history in the a VR lead T wave upright group Ratio,proportion of patients with history of myocardial infarction,proportion of patients with history of PCI,proportion of patients with history of smoking,creatine kinase isoenzyme(CK-MB),systolic blood pressure,diastolic blood pressure,D2 B,S2B,myocardial infarction lesion site,multi-site infarction,reflow after PCI,incidence of 1-year source of death,and 1-year incidence of recurrent angina pectoris showed no statistical difference(all P>0.05);(2)Compared with the a VR lead T wave inversion group,the age,serum creatinine,blood glucose,c TNI,NT-pro BNP,LVEF,number of lesion vessels,time in hospital,and incidence of MACE in the a VR lead T wave upright group were statistically significant.There were statistically significant differences(all P<0.05);and there were statistically significant differences between groups in the incidence rates of central MACE composite endpoint events including central death,cardiogenic shock,and ventricular arrhythmia(P<0.05).A total of 41 patients(6.9%)in the two groups had MACE in the hospital,including 18 patients(3.0%)with central source death,13 patients with cardiogenic shock(2.2%),and 10 patients with ventricular arrhythmia(1.7%);There were 33 cases(16.3%)of MACE in the a VR lead T wave upright group,which was higher than the 8 cases(2.0%)in the a VR lead T wave inversion group,and the difference was statistically significant(P<0.001),there were 14 cases(6.9%)of cardiac death in the a VR lead T wave upright group,and 4 cases(1.0%)in the a VR lead T wave inversion group,the difference between the two groups was statistically significant(P<0.001);a VR Cardiogenic shock occurred in 9 cases(4.4%)in the lead T wave upright group,and 4 cases(1.0%)in the a VR lead T wave inversion group,and the difference between the two groups was statistically significant(P=0.016);Ventricular arrhythmia occurred in 10 cases(4.9%)in the combined T wave upright group,and no patient in the a VR lead T wave inversion group,the difference between the two groups was statistically significant(P<0.001);(3)The recovered and discharged patients were followed up for a period of 1 year,and the composite endpoint event consisting of cardiovascular death,heart failure,and recurrent angina pectoris was regarded as MACE within 1 year.During the follow-up,63 patients(10.6 %),including 1 patient(0.2%)with cardiac death,23 patients(3.9%)with heart failure,and 39 patients(6.6%)with recurrent angina pectoris;There were 19cases(9.4%)of heart failure,and 4 cases(1.0%)in the a VR lead T wave inversion group,the difference between the two groups was statistically significant(P<0.001);There was no statistically significant difference between sexual death and recurrent angina pectoris(P=0.341,P=0.554).For MACE within 1 year,there were 35 cases(17.2%)in the a VR lead T wave upright group,which was higher than the 28 cases(7.1%)in the a VR lead T wave inversion group,and the difference between the groups was statistically significant(P<0.001);(4)The results were divided into groups based on whether or not MACE occurred in the hospital and 1 year.Through univariate analysis,age,proportion of patients with a history of diabetes,serum creatinine,blood glucose,NT-pro BNP,LVEF,D2 B,number of diseased blood vessels,and hospitalization time were found to be grouped.Upright T wave in lead a VR and lead a VR were all correlated with in-hospital MACE(P<0.05);the proportion of patients with a history of diabetes,blood sugar,number of lesion vessels and upright T wave in lead a VR were all correlated with 1-year MACE(P<0.05);(5)Through multivariate Logistic regression analysis of clinical factors with differences between groups obtained from the above univariate analysis,it was found that upright T wave in a VR lead was an independent risk factor for in-hospital MACE[OR=8.730,95%CI(3.116,24.459),P<0.001],longer entry-to-balloon time(D2B)was also an independent risk factor for in-hospital MACE [OR=1.047,95%CI(1.003,1.093),P=0.035],and higher Level of left ventricular ejection fraction(LVEF)was an independent protective factor for MACE in hospital [OR=0.908,95%CI(0.856,0.963),P=0.001].Multivariate Logistic regression analysis was performed on the influencing factors of MACE in AMI patients within one year after discharge,and it was found that T wave uprightness was also an independent risk factor for MACE in one year [OR=2.711,95%CI(1.581,4.649),P<0.001].At the same time,the number of more diseased vessels was also an independent risk factor for 1-year MACE [OR=1.479,95%CI(1.079,2.027),P=0.015];(6)In NSTEMI subgroup analysis,upright T wave in lead a VR was an independent risk factor for in-hospital MACE in NSTEMI patients [OR=35.160,95%CI(3.716,332.669),P=0.002];it was also an independent risk factor for MACE within 1year.Risk factors [OR=3.164,95%CI(1.291,7.753),P=0.012].In STEMI subgroup analysis,upright T wave in lead a VR was an independent risk factor for in-hospital MACE in STEMI patients [OR=4.910,95%CI(1.385,17.410),P=0.014];it was also an independent risk factor for MACE within 1 year.Risk factors [OR=2.965,95%CI(1.453,7.753),P=0.003];(7)According to the amplitude of the T wave in the a VR lead of the patient,the value of amplitude <-0.2m V is assigned as 1,the value of-0.2≤T<-0.1m V is assigned as 2,the value of-0.1≤T<0m V is assigned as 3,and the value of 0≤T<+0.1m V is assigned 4,+0.1m V≤T<+0.2m V is assigned as 5,and ≥+0.2m V is assigned as 6;as indicated by the ROC curve,the area under the curve for the diagnosis of MACE in the a VR lead and T lead is 0.764,The optimal cut-off value is 3.5,that is,the T wave amplitude in a VR lead ≥ 0m V has a high predictive value for in-hospital MACE in AMI patients after PCI;The area is 0.635,and the best cut-off value is 3.5.Conclusion: In patients with AMI,the upright T wave in lead a VR is related to inhospital and long-term MACE,and is an independent risk factor;and it has certain predictive value for the occurrence of adverse events in hospital;T wave in a VR lead in AMI patients The upright detection rate was 34.1%,and the upright detection rate of a VR lead T wave in STEMI patients was 33.2%. |
