目的 探讨aVR导联ST段抬高回落在非ST段抬高型急性冠脉综合征(NSTE-ACS)患者短期预后中的评估价值.方法 纳入NSTE-ACS aVR导联抬高的患者45例;根据入院6 h后aVR导联ST段是否回落分为ST段回落组(n=20)与非ST段回落组(n=25);分析入选患者一般临床资料、心电图、冠状动脉造影结果,并对不良心脏事件的危险因素进行Logistic回归分析.结果 aVR导联ST段无回落组左主干+三支血管病变率、30 d内再发心肌梗死率、急诊PCI及冠脉旁路移植术比例均高于ST段回落组患者,具有统计学差异(P＜0.05).Logistic回归分析显示,aVR导联ST段无回落是入院后30 d内不良心脏事件(死亡、心肌梗死及行血运重建术)独立预测因子(OR=18.54,95%CI:3.57～96.1,P＜0.001).结论 aVR导联ST段抬高无回落的NSTE-ACS患者其预后差于ST段抬高回落者,aVR导联ST段无回落是NSTE-ACS不良心血管事件的独立预测因子.%Objective To discuss the appraisal value of ST-segment changes in lead aVR to short-term prognosis in the patients with non-ST-elevation acute coronary syndrome ( NSTE-ACS ). Methods The patients with NSTE-ACS and lead aVR elevation ( re = 45 ) were selected and divided into ST-segment fall-back group ( fall-back group,n =20 ) and non-ST-segment fall-back group ( non-fall-back group,re = 25 ) according to the changes of ST-segment in lead aVR in the patients after hospitalization for six hours. The general clinical materials and results of ECG and coronary angiography ( CAG ) were analyzed. The risk factors of major adverse cardiac events ( MACE ) were analyzed with Logistic regression. Results The morbidity of left main coronary artery and three-vessel disease, incidence of relapsed myocardial infarction within 30 days, and proportion of emergency PCI and coronary artery bypass grafting were higher in non-fall-back group than those in fall-back group ( P < 0. 05 ). The analysis of Logistic regression showed that non-fall-back of ST-segment in lead aVR was an independent predictive factor to MACE ( death, myocardial infarction and revascularization ) in the patients within 30 days after hospitalization ( OR = 18. 54,95% CI:3. 57 ~ 96. 1 ,P <0. 001 ). Conclusion The prognosis is poorer in NSTE-ACS patients with ST-segment elevation and without ST-segment fall-back in lead aVR than that in NSTE-ACS patients with ST-segment elevation and fall-back. The non-fall-back of ST-segment in lead aVR is an independent predictive factor to MACE of NSTE-ACS.
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