老年急性心肌梗死患者中碎裂QRS波的发生及意义

Incidence and significance of fragmented QRS in elderly patients with acute myocardial infarction

目的探讨静息心电图中碎裂QRS波(f QRS)在老年急性心肌梗死(AMI)患者中的发生率及与心血管事件的相关性。方法分析192例老年AMI患者的临床资料,根据入院72 h内记录的静息心电图有无f QRS的情况分成f QRS组和对照组,研究f QRS的发生率,f QRS出现的导联与冠状动脉造影结果的相关性,对患者进行随访,探讨f QRS与心血管事件的相关性。结果 192例中出现f QRS者有116例(60.41%),其中下壁102例(87.9%),前壁56例(48.3%),侧壁30例(25.9%),右室面21例(18.1%),后壁8例(6.9%),f QRS在下壁的发生率显著高于其他各壁(P<0.05);f QRS出现的导联与冠状动脉造影结果有较高的符合率(84.1%),当犯罪血管累及多支血管时,f QRS的发生率显著升高,并且其发生心血管事件的概率升高;随访(29.5±5.2)个月,f QRS组再发心肌梗死、高度以上房室传导阻滞、室性心动过速/心室颤动等心血管事件的发生率显著高于对照组(P<0.05)。结论 f QRS在下壁的发生率显著高于其他各壁;当犯罪血管累及多支血管时,f QRS的发生率显著升高,并且其发生心血管事件的概率升高;f QRS组总的心血管事件的发生率显著升高,预后不佳。

Objective To investigate the incidence of fragmented QRS （fQRS） complexes in patients of acute myocar- dial infarction in elderly population（ ≥ 65 years）, and to analyze the relationship between fQRS and cardiac events. Methods Standard electrocardiogram within 72 h of hospitalization with 192 patients with acute myocardial infraction in elderly people were assessed and analyzed for the presence of fQRS. Patients were divided into two groups based on the presence of fQRS and were followed up for 6 to 36 months to observe the cardiac events. Results fQRS was detected in a total of 116 patients（ 60.41% ） out of 192 cases and the incidence of fQRS in the inferior leads, anterior leads, lateral leads, right ventricular leads and the posterior leads was 87.93 % （ n = 102）, 48.28 % （ n = 56）, 25.86% （ n = 30）, 18.1% （ n = 21 ） and 6.9 % （ n = 8 ） respectively. The frequency of fQRS in the inferior leads was significantly higher than that in the other leads ; Coronary lesions was found in 73 patients out of the 74 cases performed coronary angiography in the study, the results showed that the incidence of multi-vessels （3 or more） disease were significantly higher in fQRS group. During the period of following up, the incidence of re-infraction, high degree or absolutely atrio-ventrieular block, ventricular tachycardia./ventricular fibrillation malignant arrhythmia events was significantly higher in the patients presenting fQRS（P〈0.05）. Conclusions The incidence of fQRS in the inferior wall is significantly higher than that in the other walls. Meanwhile. the incidence of fORS as well as the cardiac events are siznificantlv hizher when multi-vessels （3 or more） are involved. The total frequency of cardiac events in fQRS group increase significantly and also with the worse clinic prognosis.