胸前导联QRS波群特征与经皮冠状动脉介入术治疗急性前壁ST段抬高型心肌梗死患者预后的相关性研究

A correlation study between precordial QRS complex characteristics and the prognosis of patients with acute anterior ST-segment elevation myocardial infarction treated by percutaneous coronary intervention

目的探讨影响经皮冠状动脉介入术(percutaneous coronary intervention,PCI)治疗急性前壁ST段抬高型心肌梗死(ST-segment elevation myocardial infarction,STEMI)患者预后的胸前导联QRS波群危险特征,并建立基于胸前导联QRS波群特征的风险评分模型。方法选取2016年1月至2019年6月在中国中医科学院望京医院经PCI治疗的急性前壁STEMI患者273例,以术后随访期间发生主要心血管不良事件(major adverse cardiac event,MACE)为终点事件,根据患者出院时心电图胸前导联QRS波群特征,经Cox分析判断影响患者预后的胸前导联QRS波群危险特征,并据此建立基于心电图胸前导联QRS波群特征的风险评分模型。结果273例患者中MACE发生率为20.15%(55例),平均随访时间为(24.25±3.91)个月。Cox回归分析显示,QRS波群时限(HR=1.043,95%CI 1.025~1.061,P<0.001)、存在Q波(HR=2.078,95%CI 1.148~3.762,P=0.016)、存在碎裂QRS波群(HR=1.955,95%CI 1.121~3.409,P=0.018)、累计胸前导联个数≥3(HR=2.728,95%CI 1.409~5.282,P=0.003)、胸前导联累积R波幅度总和(HR=0.973,95%CI 0.955~0.992,P=0.005)、胸前导联R波振幅总和/(S波+Q波)振幅总和比值[R/(Q+S)](HR=0.291,95%CI 0.118~0.715,P=0.007)为预测本研究定义的MACE发生的胸前导联QRS波群危险特征。基于胸前导联QRS波群危险特征建立的风险评分模型预测MACE具有良好的准确性且AUC为0.722。结论基于心电图胸前导联QRS波群特征的风险评分预测模型在PCI治疗急性前壁STEMI患者中对预后判断具有一定的临床价值。

Objective To explore the risk characteristics of precordial QRS complexes with the prognosis of patients undergoing percutaneous coronary intervention(PCI)for acute anterior ST-segment elevation myocardial infarction(STEMI)and to develop a risk scoring model based on these precordial QRS complex characteristics.Methods A total of 273 patients with acute anterior STEMI treated by PCI at Wangjing Hospital of China Academy of Chinese Medicine Sciences from January 2016 to June 2019 were selected.The primary outcome measure was major adverse cardiac events(MACE)during the follow-up period.Cox regression models were employed to identify risk predictors based on the precordial QRS complex characteristics at discharge and to establish a risk scoring model.Results Among the 273 patients,the incidence of MACE was 20.15%(55 cases),and the average follow-up time was(24.25±3.91)months.Cox regression analysis revealed that the following precordial QRS complex characteristics were predictive of MACE occurrence:QRS duration(HR=1.043,95%CI 1.025-1.061,P<0.001),presence of Q wave(HR=2.078,95%CI 1.148-3.762,P=0.016),presence of fragmented QRS wave(HR=1.955,95%CI 1.121-3.409,P=0.018),cumulative number of precordial leads≥3(HR=2.728,95%CI 1.409-5.282,P=0.003),cumulative sum of precordial lead R wave amplitudes(HR=0.973,95%CI 0.955-0.992,P=0.005),ratio of cumulative sum of precordial lead R wave amplitudes to(S wave+Q wave)amplitudes[R/(Q+S)](HR=0.291,95%CI 0.118-0.715,P=0.007).Based on these findings,a risk scoring model was developed,which demonstrated good accuracy with an area under the curve(AUC)of 0.722 for predicting MACE.Conclusion The risk scoring model based on precordial QRS complex characteristics shows promise in predicting the prognosis of patients with acute anterior STEMI undergoing PCI.