急性心肌梗死后早期QRS波增宽对远期心脏性猝死发生的预测分析

Predictive analysis of QRS wave widen on the incidence of long-term sudden cardiac death during the early phase after acute myocardial infarction

目的探讨急性心肌梗死后早期心电图QRS波增宽预测远期心脏性猝死（SCD）发生的价值。方法选择259例急性心肌梗死后存活患者，在早期（≤30d）采用超声测定左心室射血分数（LVEF），体表心电图测定QRS波时限和QTc间期，临床随访观察（16．5±3．8）个月发生的SCD事件。根据随访结果将患者分为SCD组和存活组。结果随访期内8．1％（21／259）患者发生SCD。与存活组患者比较，SCD组患者的LVEF明显降低[（35．8±8．2）％比（53．3±6．0）％]，差异有统计学意义（P=0．016），QRS波明显增宽[（118．8±15．2）ms比（91．5±13．6）ms]，差异有统计学意义（P=0．023），而两组患者QTc间期比较差异无统计学意义（P=0．184）。LVEF降低、QRS波增宽和QTc间期延长预测SCD的灵敏度依次为42．9％（9／21）、66．7％（14／21）和38．1％（8／21）。多元Logistic回归分析显示，院前电复律／除颤史（RR=6．514，P=0．011）、LVEF降低（RR=7．325，P=0．005）和QRS波增宽（RR=4．023，P=0．024）为SCD发生的独立危险因素。结论急性心肌梗死后早期QRS波增宽能独立预测远期SCD的发生。

Objective To investigate the predictive value of QRS wave widen on the incidence of long-term sudden cardiac death （SCD） during the early phase after acute myocardial infarction （AMI）. Methods Two hundred and fifty-nine survived patients with AMI were enrolled. The left ventricular ejection fraction （LVEF） was measured by echocardiography,and the QRS duration and the QTc interval were measured automatically by electrocardiography during the early phase （≤30 d） after AMI. The time of follow-up was （ 16.5 ± 3.8 ） months, and the incidence of SCD was observed. The patients were divided into SCD group and survived group according to the follow-up outcome. Results The incidence rate of SCD was 8.1% （21/259 ）.The LVEF in SCD group was significantly lower than that in survived group [ （35.8 ~ 8.2）% vs. （53.3 ~ 6.0）% ] ,and there was statistical difference （P = 0.016）. The QRS duration was significantly wider than that in survived group [（118.8 ± 15.2） ms vs. （91.5 ±13.6） ms],and there was statistical difference （P= 0.023）. There was no statistical difference in QTc interval between the 2 groups（P= 0.184）. In SCD group,the percentage of patients with decreased LVEF,widen QRS wave and QTc interval prolongation was 42.9% （9/21）,66.7% （14/21） arid 38.1% （8/21）,respectively. The multielement Logistic regression analysis result showed that prehospital electrical conversion/defibrillate （RR = 6.514,P = 0.011 ）,LVEF decreased （RR = 7.325,P = 0.005 ） and QRS wave widen （RR = 4.023,P = 0.024） were the independent risk factors of SCD. Conclusion QRS wave widen is an independent risk factor for SCD in patients withAMI.