ST段压低碎裂QRS波可能是NSTE-MI病死率的预警指标

ST segment depression fQRS may be a new predictor of mortality of non-ST elevation myocardial infarction

目的观察非ST段抬高心肌梗死(NSTE-MI)后48h内出现碎裂QRS波(fQRS)和ST段压低fQRS(STD-fQRS)的发生率,并探讨fQRS、STD-fQRS对NSTE-MI患者病死率的预警价值。方法纳入NSTE-ACS患者为研究对象,根据其心电图结果,将NSTE-MI患者分为fQRS组和无fQRS组,再将fQRS组分为STD-fQRS和无STD-fQRS两个亚组,长期随访观察其病死率。结果 (1)共纳入731例NSTE-ACS,其中NSTE-MI组609例,UA组122例。NSTE-MI组出现fQRS的比率明显高于UA组。(2)fQRS组近期全因病死率高于无fQRS组;亚组分析STD-fQRS组近期全因病死率高于无STD-fQRS组。长期随访表明,fQRS组全因病死率高于无fQRS组;亚组分析STD-fQRS组远期全因病死率高于无STD-fQRS组。(3)COX回归分析表明,fQRS不是NSTE-MI患者远期全因病死率独立预测性因子;NSTE-MI后48h内出现STD-fQRS是远期全因病死率独立预测性较强的因子。结论 STD-fQRS可能是NSTE-MI全因病死率独立危险预警指标。

Objective To observe the incidence of fragmented QRS complex （fQRS）and ST Segment depression fQRS （STD fQRS）during the first 48 hours after non-ST elevation myocardial infarction（NSTE MI）and discuss the value of predicting mortality in patients with NSTE MI .Methods Based on the ECGs ,the patients with NSTE MI were divided into two groups ：fQRS and non fQRS group .And then fQRS group was divided into two sub-groups ：STD fQRS and non-STD fQRS group .Their mortality was studied during long-term follow-up .Results （1）731 patients with NSTE ACS [the NSTE MI group（n=609） and the UA group（n=122）] were studied .The incidence of fQRS in the NSTE MI group was higher than that of the UA group .（2）All cause mortality in the fQRS group were higher than that in the non-fQRS group ,and all-cause mortality in the STD fQRS group were higher than that in the non-STD fQRS group ,all the above results were not only in the early stages of NSTE MI ,but also in the long term fol-low-up .（3） Multivariate Cox regression analysis revealed that STD fQRS was an independent significant predictor for all cause mortality ,but not of the fQRS .Conclusion The STD fQRS may be an independent predictor of mortality in patients with NSTE MI .