Abstract:

Objective　To investigate the value of 24-hour dynamic electrocardiogram (DCG) parameters in evaluating malignant arrhythmia (MA) after percutaneous coronary intervention (PCI) in patients with acute myocardial infarction (AMI). Methods　A total of 80 AMI patients treated by PCI in Nanyang Second People's Hospital from June 2020 to June 2021 were selected as the research subjects, including 43 males and 37 females, aged (47.24±3.14) years. The occurrence of MA within 72 hours after operation of patients was observed and recorded, and the patients were divided into two groups according to the results. All patients underwent 24-hour DCG examination and the relevant parameters were recorded [standard deviation of R-R interval (SDNN) from 24-hour normal atrial depolarization to ventricular depolarization (R-R), standard deviation of normal R-R interval (SDANN-index) for 5 consecutive minutes in 24 hours, and 24-hour QT interval variability (QTV)]. The value of 24-hour DCG parameters in evaluating MA after PCI in patients with AMI was analyzed. Independent sample t test and χ² test were used to compare the measurement data and the count data between groups. Results　After PCI treatment in 80 patients with AMI, MA occurred in 22 cases (27.50%) within 72 hours after operation. The rate of Killip grade Ⅲ/Ⅳ of cardiac function in the MA group was higher than that in the non-MA group [63.64% (14/22) vs. 36.21% (21/58)], with a statistically significant difference (P<0.05); there were no statistically significant differences in the other data (gender, infarct area, and age) between the two groups (all P>0.05). The SDNN, SDANN-index, and 24 h-QTV values of the MA group were (73.76±10.07) ms, (67.14±6.76) ms, and (18.69±4.15) ms, respectively, which were lower than those in the non-MA group [(84.47±10.75) ms, (73.38±6.84) ms, and (23.53±3.04) ms], with statistically significant differences (all P<0.05). The results of receiver operating characteristic curve (ROC) showed that SDNN, SDANN-index, and 24 h-QTV alone and combined examination all had certain values in evaluating MA after PCI in AMI patients, and the areas under the curve (AUC) were >0.7, among which the combined examination had the highest evaluation value. Conclusion　24-hour DCG parameters have certain values in evaluating the occurrence of MA in AMI patients after PCI.

Key words: Acute myocardial infarction, Percutaneous coronary intervention, Dynamic electrocardiogram, Malignant arrhythmia

摘要： 目的　探讨24 h动态心电图参数评估急性心肌梗死（AMI）患者经皮冠状动脉介入术（PCI）治疗后恶性心律失常（MA）的价值。方法　选择2020年6月至2021年6月南阳市第二人民医院收治的80例行PCI治疗的AMI患者为研究对象，其中男43例、女37例，年龄（47.24±3.14）岁；观察并记录患者术后72 h内MA发生情况并分组，所有患者术后均接受24 h动态心电图检查并记录相关参数［24 h正常心房开始除极到心室开始除极时间（R-R）间期标准差（SDNN）、24 h连续5 min正常R-R间期标准差（SDANN-index）、24 h QT间期变异性（QTV）］，分析24 h动态心电图参数评估AMI患者PCI治疗后MA的价值。计量资料组间比较采用独立样本t检验，计数资料采用χ²检验。结果　80例AMI患者PCI治疗后，术后72 h内经评估，27.50%（22/80）发生MA，72.50%（58/80）未发生MA。MA组心功能Killip分级Ⅲ/Ⅳ级患者占比为63.64%（14/22），高于非MA组36.21%（21/58），差异有统计学意义（P<0.05）；两组其余资料（性别、梗死部位、年龄）比较，差异均无统计学意义（均P>0.05）。MA组SDNN、SDANN-index、24 h-QTV值分别为（73.76±10.07）ms、（67.14±6.76）ms、（18.69±4.15）ms，均低于非MA组（84.47±10.75）ms、（73.38±6.84）ms、（23.53±3.04）ms，差异均有统计学意义（均P<0.05）。绘制受试者工作特征曲线（ROC）结果显示，SDNN、SDANN-index、24 h-QTV单独及联合检查评估AMI患者PCI后MA均有一定价值，曲线下面积（AUC）均>0.7，其中联合检查评估价值最高。结论　24 h动态心电图参数对评估AMI患者PCI治疗后AMI发生具有一定价值。

关键词: 急性心肌梗死, 经皮冠状动脉介入术, 动态心电图, 恶性心率失常