碎裂QRS波与急性ST段抬高心肌梗死冠脉血流恢复之间的联系

Correlation between fragmented QRS complexes and coronary reflow post PCI in acute ST-elevation myocardial infarction patients

目的评价体表心电图碎裂QRS(fragmented QRS,fQRS)与急性ST段抬高心肌梗死病人行经皮冠状动脉介入治疗(PCI)术后冠脉血流恢复的状况之间的关系。方法选取2015年1月至2016年4月在安徽省立医院诊断为新发的ST段抬高心肌梗死经急诊PCI治疗的病人128例。术后第2天做十二导联体表心电图分析fQRS,与PCI术后即时梗死相关动脉的TIMI血流评分进行分析,术后一周行超声心动图检查。结果 TIMI评分低的病人体表心电图fQRS多见,与无fQRS的病人相比,病人冠脉血流TIMI 3级构成比差异有统计学意义(77.3%比60.4%,P=0.003)并且射血分数(EF)值降低[(54.4±8.4)%比(48.3±8.5)%,P=0.031]。相关分析结果显示fQRS与左室EF呈负相关(r=-0.532,P=0.012),TIMI评分与fQRS呈负相关(r=-0.324,P=0.001)。结论碎裂QRS的出现与急性心肌梗死病人心肌缺血有密切关系,可以作为评价其冠状动脉血流恢复的一种简单、无创的检查。

Objective To assess the correlation between fragmented QRS complexes(fQRS)and myocardial reflow post emergency percutaneous coronary intervention(PCI)in acute ST-elevation myocardial infarction(STEMI)patients.Methods Totally 128 STEMI patients in Anhui Provincial Hospital from January 2015 to April 2016 who received emergency percutaneous coronary intervention were included.fQRS analysis was performed using 12-lead surface electrocardiogram(ECG)on the next day after surgery.The results were combined with thrombolysis in myocardial infarction(TIMI)flow grade for the infarcted artery immediately after PCI.Ultrasonic cardiogram(UCG)was performed one week after surgery.Results fQRS was more frequent upon surface ECG for those with low TIMI scores.As compared with patients without fQRS,TIMI scores of the coronary artery were significantly different(77.3%vs.60.4%,P=0.003)and left ventricular ejection fraction(EF)decreased significantly[(54.4±8.4)%vs.(48.3±8.5)%,P=0.031]in patients with fQRS.Correlation analysis indicated that fQRS correlated negatively to EF of the left ventricle(r=-0.532,P=0.012),and TIMI score was negatively correlated with fQRS(r=-0.324,P=0.001).Conclusions fQRS is closely associated with myocardial ischemia in patients with acute myocardial infarction.It can be used as a simple and non-invasive evaluation method of myocardial reperfusion.