急性心肌梗死患者48h内出现与未出现碎裂QRS波的预后分析

Study on prognostic analysis of patients with myocardial infarction within 48 h with or without fragmented QRS wave

目的探讨急性心肌梗死48 h内出现碎裂的QRS波(f QRS)和未出现碎裂QRS波患者的临床、住院情况和预后。方法收集2009年1月至2012年6月发病48 h内急诊科收治后转入心内科住院的急性心肌梗死患者159例,根据心电图的检查出现及未出现碎裂的QRS波分为实验组和对照组。比较两组患者在住院期间发生心血管事件和心源性死亡的情况,在患者出院后,对患者进行为期3年的随访,比较两组患者随访期间心脏原因住院和死亡事件发生的情况分析。结果实验组患者住院期间在心源性休克、心源性猝死、心律失常、心力衰竭及心绞痛和左室射血分数降低的发生率高于对照组(P<0.05)。随访期间实验组因心血管死亡的患者比率高于对照组,因心梗死亡患者比率比较差异无明显统计学意义,实验组3年随访住院的人数明显多于对照组(P<0.05)。Kaplan-Meier生存曲线分析提示:实验组病死率高于对照组,生存率低于对照组患者。运用COX回归分析显示:年龄、糖尿病史、吸烟史、Killip≥2级及f QRS波时ST段抬高型急性心肌梗死患者远期全因病死率独立预测性较强的因子。结论急性心肌梗死48 h内出现碎裂的QRS波是ST段抬高心肌梗死的高危预警标志,预示可能出现高危心脏时间的发生率,在临床上值得重视。

Objective To explore the clinical manifestations and mortality of patients with acute myocardial infarction（ MI） appearing fragmented QRS wave（ f QRS） or without fragmentation of QRS complex within 48 h,their condition of hospitalization,the incidence of cardiovascular events and cardiac death during the follow- up period of 3 years. Methods A total of 159 patients with acute myocardial infarction admitted into the Department of Cardiology of this hospital within 48 h after the onset of disease during January 2009 to June 2012 were allocated in this study,and they were divided into trial group and control group according to ECG examination with or without fragmentation of QRS complex,patients in trial group were having fragmented QRS complex,and patients in control group were without fragmented QRS complex,the incidence rates of cardiovascular events and cardiac death were compared between these two groups during hospitalization,after discharge,and follow- up period of3 years. Results The incidence rates of cardiogenic shock,sudden cardiac death,arrhythmias,heart failure,angina and reduced LVEF occurred in patients of trial group during hospitalization were higher than those of patients in control group（ P 〈 0. 05）,and the rate of deaths due to cardiovascular event in patients of trial group during the follow- up period was less than that of patients in control group,and the difference in mortality due to myocardial infarction between these 2 groups was not statistically significant,and the number of re- hospitalized patients during the 3- year follow- up period in trial group was significantly larger than that of patients in control group（ P 〈 0. 05）. Kaplan- Meier survival curve analysis showed that： the mortality in trial group was higher and its survival rate was lower than that of control group. The COX regression analysis showed：that age,history of diabetes,smoking history,Killip≥2 level and QRS wave with elevated ST segment in patients with acute myocardial infarction were independent predictors of long- term all- cause mortality strong factors. Conclusion The occurrence of fragmented QRS wave within 48 h in patients with acute myocardial infarction is early high risk warning sign of ST- segment elevation myocardial infarction,indicating the possible incidence of high- risk in cardiac events,it should deserve attention in clinical practice.