| Objective To explore the incidence,clinical features,electrocardiographic features,coronary artery lesions and prognosis of De Winter(DW)ECG phenomenon in patients with acute myocardial infarction(AMI),so as to provide reference for clinical diagnosis and treatment.Methods A total of 90 patients with acute myocardial infarction treated in the Cardiovascular Department of Enshi Central Hospital from January 2018 to September 2020 were selected according to the inclusion and exclusion criteria.They were divided into two groups: DW ECG phenomenon group(n=30)and anterior wall ST segment elevation myocardial infarction group(n=60).A comparative study was made on the general data,laboratory examination indexes,cardiac function classification,ECG evolution characteristics,echocardiographic indexes,coronary artery lesions and prognosis of patients with DW ECG phenomenon group(DW group)and anterior wall ST segment elevation myocardial infarction group(control group).Results(1)among the 665 patients with acute myocardial infarction,30 patients were consistent with DW ECG phenomenon,accounting for 4.5% of acute myocardial infarction.(2)compared with the control group,the patients in the DW group were younger(56.03 ±11.51 vs.61.70±9.44 years,p=0.015),including 24 males(80%),6 females(20%)and 20 patients aged 50-69 years(67%).(3)The hospital stay of patients in DW group was shorter than that in control group,and the onset time to visit the doctor was earlier than that in control group.Heart rate,MYO,NT-pro BNP,WBC,NEUT and AST were higher than those in control group,TC,TG and LVEF were higher than those in control group,and the difference was statistically significant(P<0.05).(4)in patients with DW ECG phenomenon,the time from onset to the first ECG was 143.6(23-326)minutes,the average heart rate was 70(44-105)beats / min,and the PR interval,QRS wave duration and QTC interval were basically normal.(5)some of the DW ECG phenomena showed dynamic evolution,of which 6 cases(20%)developed into STEMI ECG manifestations,with an average evolution time of 96.67(34-185min).(6)Coronary artery condition: There were 21 cases(70%)of single vessel disease in the DW group,including 13 cases of proximal LAD disease,2 cases of middle segment disease,5 cases of LCX disease,and 1 case of blunt marginal branch disease.6 cases(20%)of two-vessel disease,including 1 case of LAD+RCA,the criminal vessel was LAD;1 case of LAD+diagonal branch,the criminal vessel was the diagonal branch;LAD+LCX 1 case,the criminal vessel was LAD;LCX+diagonal branch In 2 cases,the culprit’s blood vessel was the diagonal branch;in 1 case of RCA+LCX,the culprit’s blood vessel was RCA.Three diseased vessels(LAD+LCX+RCA)were in 2 cases,and the culprit vessel was LCX and 1 LAD each.One patient showed no obvious stenosis on coronary angiography,and coronary spasm was considered.The formation rate of collateral circulation in the DW group was lower than that in the control group(10%vs.16.7%,P=0.596).(7)the prognosis of the DW group during hospitalization and 6 months after discharge was better than that of the control group,the incidence of MACCE and malignant arrhythmia was lower than that of the control group.(8)the results of multivariate Logistic regression analysis showed that WBC(OR=0.389,95%CI:0.201-0.753),MYO(OR=0.991,95%CI:0.984-0.997),CTn T(OR=0.998,95%CI:0.997-1.000),NEUT(OR=1.142,95%CI:1.028-1.268),TC(OR=4.591,95%CI:1.823-11.559),TG(OR=11.914,95%CI:2.590-54.804)and the time from onset to visit(OR=0.841,95%CI:0.207-0.784)were related to DW ECG phenomenon(P<0.05).Conclusion(1)The incidence of DW ECG phenomena was 4.5%,in which males were more than females,and the age was younger than the control group,mainly aged50-69 years,and most of them were associated with hyperlipidemia.(2)DW ECG phenomenon mainly appears about 2 hours after onset,and some patients with DW ECG phenomenon can evolve into STEMI,with an average evolution time of 1.5hours.(3)The culprit vessels of DW ECG phenomenon were mainly single vessels in the proximal middle segment of the anterior descending branch,but also circulatory branch,branch and multi-branch lesions.Coronary spasm can also be observed with DW ECG phenomenon.The incidence of collateral circulation is lower in patients with DW ECG phenomenon.(4)Early intervention of DW ECG phenomenon and opening of infarct related coronary vessels can significantly improve the prognosis of patients and improve the quality of life of patients after myocardial infarction.(5)MYO,CTn T,WBC,NEUT,TC,TG and the time from onset to visit were related to the occurrence of DW ECG phenomenon in patients with AMI. |
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