Combining fragmented QRS and TIMI score for predicting in-hospital short-term prognosis after acute myocardial infarction

碎裂QRS波联合TIMI危险评分预测急性心肌梗死患者的短期预后（英文）

Acute myocardial infarction （AMI） has a high mortality rate and poor prognosis for patients. The primary causes of death are arrhythmia and heart failure. For patients admitted because of myocardial infarction, various risk evaluations are initiated to foresee possible complications. The thrombolysis in myocardial infarction （TIMI） risk score, which can be used to predict the prognosis and the need for revas-cularisation, is the most convenient and commonly used system, but is inadequate for AMI patients on admittance. Fragmented QRS （fQRS） has been shown to be a valuable electrocardiographic （ECG） index for predicting the prognosis of patients with coronary heart disease （Das et al., 2006, 2007）.

目的:探讨碎裂QRS波(fQRS)联合心肌梗死溶栓治疗临床试验(TIMI)危险评分对急性心肌梗死(AMI)患者短期预后的评估价值。创新点:TIMI危险评分常用于AMI患者入院即刻的风险评估,TIMI评分<4分的患者被评定为中危组。本研究发现,无论TIMI评分如何,出现fQRS而未行经皮冠状动脉介入治疗(PCI)的患者,其死亡率均显著升高。fQRS联合TIMI危险评分更利于AMI患者的预后评估,TIMI评分<4分但同时合并fQRS的患者,可以从早期PCI介入治疗获益。方法:回顾300例AMI患者的临床资料及院内诊治经过,记录分析患者fQRS出现的时间、部位及其他临床转归,评价fQRS联合TIMI危险评分与患者临床预后的关系。结论:(1)fQRS联合TIMI危险评分可提高恶性心律失常、左室收缩功能不全(LVSD)和死亡预测的敏感度和特异度;(2)fQRS阳性的AMI患者,进行早期血运重建可降低患者心血管事件发生率,fQRS可能作为TIMI评分<4分患者早期介入治疗的指征。