The relationship between coronary artery lesions and malignant arrhythmia in STEMI patients

Objective To investigate the relationship between the severity of coronary artery disease and malignant arrhythmia in the acute ST segment elevation myocardial infarction （STEMI） undergoing primary percutaneous coronary intervention （PCI）, and guide clinical prevention and treatment .Methods By retrospective analysis method , 418 cases of hospitalized patients with a diagno-sis of STEMI undergoing direct PCI were continuously collected in the Department of Cardiology , the First Affiliated Hospital of China Medical University, from 2008 January to 2010 December.Electrocardiography （ECG） was given after admission.Those patients were divided into two groups according to whether the occurrence of malignant ventricular arrhythmias that was defined as sustained ventricu -lar tachycardia （sVT） or ventricular fibrillation （VF）].In sVT/VF patients, the preoperative and postoperative groups were divided according to sVT/VF time.The degree of coronary artery lesions was calculated in patients with STEMI .The incidence of sVT/VF was counted in each group with Gensini scores 〈60,≥60 and〈120, and ≥120.The relationship between the severity of coronary le-sions and malignant arrhythmia was observed in STEMI undergoing direct PCI patients .Results ⑴In this study , a total of 47 cases （ 11.2%） occurred with sVT/VF in patients;Killip grade 〉I, fast heart rate , low blood pressure , and low ejection fraction were risk factors of sVT/VF（ P 〈0.05）.The occurrence of sVT/VF among the Gensini groups were significant difference （7.1%vs 10.8%vs 20.5%, P =0.012 ） .⑵The occurrence of sVT/VF was 44.8% （ 22 patients ） with direct PCI before operation; the preoperative sVT/VF rate among the Gensini groups had significant difference （2.1%vs 5.9%vs 9.6%, P =0.045）.⑶The occurrence of sVT/VF is 53.3%（25 patients） with direct PCI after operation; the postoperative sVT/VF rate among Gensini groups had no significant difference（5.0%vs 4.9%vs 11.0%, P =0.142）;⑷Paired with age （ x±2）, gender, hypertension, and diabetes 1, Logistic re-gression analysis showed that the heart rate greater than 80 beats /min （ P =0.04 , OR：2.667 , 95%CI：1.043-6.815 ） was an independent risk factor of preoperative sVT/VF, that Gensini score was not an independent risk factor of preoperative malignant ar -rhythmia.Conclusions For STEMI PCI patients, the more serious the degree of coronary artery is , the higher may be preoperative＆amp;nbsp;malignant arrhythmia , while the postoperative malignant arrhythmia rate has no significant difference . Key words: Myocardial infarction/therapy; Angioplasty,transluminal,percutaneous coronary; Arrhythmias,cardiac; Tachy-cardia,ventricular; Ventricular fibrillation