摘要
目的 探讨24小时动态心电图参数联合血清脑钠肽(BNP)、C反应蛋白(CRP)对急性心肌梗死(AMI)患者经皮冠状动脉介入(PCI)术后恶性心律失常(MVA)的预测价值.方法 选择2020年6月至2023年6月安远县人民医院收治的179例行PCI治疗的急性心肌梗死患者,根据PC1术后72小时内是否发生MVA将患者分为MVA组(n=50)和非MVA组(n=129).术前行24小时动态心电图检查获得相关参数,并检测BNP、CRP水平.受试者工作特征(ROC)曲线分析24小时动态心电图参数联合血清BNP、CRP对PCI术后MVA的预测价值.结果 MVA组24小时QT间期变异性(24h-QTV)、24小时正常心房开始除极到心室开始除极时间(RR)间期标准差(SDNN)、24小时连续5分钟正常RR间期标准差(SDANN-index)、24小时连续5分钟正常RR间期标准差均值(SDNN-index)低于非MVA组(P＜0.05),血清BNP、CRP水平高于非MVA 组(P＜0.05).二十四小时 QTV、SDNN、SDANN-index、SDNN-index、BNP、CRP 预测急性心肌梗死患者PCI术后MVA的曲线下面积为0.723、0.726、0.758、0.762、0.803、0.658,联合预测曲线下面积为0.928,高于单独预测.结论 急性心肌梗死PCI术后MVA患者24小时QTV、SDNN、SDANN-index、SDNN-index降低,血清BNP、CRP水平增高.二十四小时动态心电图参数联合血清BNP、CRP对PCI术后MVA风险具有较高预测价值.
Abstract
Objective To investigate the predictive value of 24-hour dynamic electrocardiogram parameters combine with serum brain natriuretic peptide(BNP)and C-reactive protein(CRP)for malignant ventricular arrhythmia(MVA)after percutaneous coronary intervention(PCI)in patients with acute myocardial infarction.Methods One hundred and seventy-nine patients with acute myocardial infarction who underwent PCI in Anyuan County People's Hospital from June 2020 to June 2023 were selected,patients were divided into MV A group(n=50)and non-MVA group(n=129)according to whether MVA occurred within 72 hour after PCI.The related parameters were obtained by 24-hour dynamic electrocardiogram before operation,and the levels of BNP and CRP were detected.The predictive value of 24-hour dynamic electrocardiogram parameters combined with serum BNP and CRP for MVA after PCI were analyzed by receiver operating characteristic(ROC)curve.Results Twenty-four-hour QT interval variability(24-hour QTV),24-hour normal atrial depolarization to ventricular depolarization time(RR)interval standard deviation(SDNN),24-hour continuous 5 min normal RR interval standard deviation(SDANN-index),24-hour continuous 5 min normal RR interval standard deviation mean(SDNN-index)in MVA group were lower than those in non-MVA group(P＜0.05),serum BNP and CRP levels were higher than those in non-MVA group(P＜0.05).The area under the curve of QTV,SDNN,SDANN-index,SDNN-index,BNP and CRP in predicting MVA after PCI in patients with acute myocardial infarction was 0.723,0.726,0.758,0.762,0.803 and 0.658 respectively,the area under the curve of combined prediction was 0.928,which was higher than that of single prediction.Conclusions The 24-hour QTV,SDNN,SDANN-index and SDNN-index of MVA patients with acute myocardial infarction after PCI are decrease,and the levels of serum BNP and CRP are increase.24-hour dynamic electrocardiogram parameters combine with serum BNP and CRP have high predictive value for MVA risk after PCI.
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