QRS碎裂波对行介入治疗的急性心肌梗死患者不良心血管事件的影响

Effect of fQRS on main adverse cardiac events in patients with acute myocardial infarction undergoing coronary intervention

目的:分析fQRS与冠脉狭窄程度及主要不良心血管事件(MACE)的相关性,探讨其预测价值。方法:试验共纳入因急性心肌梗死(AMI)接受经皮冠状动脉介入(PCI)治疗的患者261例(其中心电图存在fQRS患者147例,无fQRS患者114例)。分析比较患者的一般临床资料、Gensini评分,随访(14.2±0.8)月内MACE的情况。结果:(1)与无fQRS组相比,心电图存在fQRS的患者肌钙蛋白、肌酐、尿酸水平及Gensini评分较高,射血分数较低(P<0.05)。(2)Kaplan-Meier生存分析提示fQRS组免于MACE的概率低于无fQRS组,Log-rank检验P<0.001。两组免于心源性死亡的生存率无显著性差异,Log-rank检验P=0.115。(3)多因素Cox回归分析显示糖尿病史、左室射血分数、心梗48 h内心电图是否存在fQRS是预测MACE的独立危险因素。结论:心梗48 h内出现fQRS是接受PCI治疗的AMI患者不良心血管事件的独立预测因子。

Objective： To investigate effect of fQRS on the degree of coronary stenosis and main adverse cardiac events （MACE） in patients with acute myocardial infarction （AMI） who underwent percutaneous coronary intervention （PCI）. Methods： The study included 261 consecutive patients with AMI who underwent PCI .Who were divided into two groups：ECG with fQRS （n=147） and without fQRS （n=114）. Baseline clinical characteristics, Gensini score and the incidence of MACE up to（14.2±0.8） month after AMI were compared between the two groups. Results： （1）Patients with fQRS of ECG had higher cTnI levels and Gensini score, lower left ventricular ejection fraction （LVEF）in comparison with patients with non-fragmented QRS （P 〈0.05）. （2）A Kaplan-Meier analysis showed a significantly lower MACE events-free rate in patients with fQRS than those without fQRS （Log-rank test： P 〈0.001）. The cardiac mortality rates were no difference between two groups （Log-rank test： P =0.115）. （3）A multivariate Cox proportional hazards regression analysis indicated that diabetes mellitus disease, LVEF and the presence of fQRS at the 48th hour were independent predictors of MACE. Conclusion： The presence of fQRS at 48 h is an independent predictor of MACE in patients with AMI undergoing PCI.