碎裂QRS波与急性心肌梗死患者预后的关系研究

Relationship between fragmented QRS complex and prognosis of patients with acute myocardial infarction

目的探讨碎裂QRS(fragmented QRS,f QRS)波与急性心肌梗死(acute myocardial infarction,AMI)预后的关系。方法入选287例AMI患者,根据心电图是否存在f QRS波分为fQRS组和无f QRS组,采集相关临床资料。随访1~36个月的心源性死亡和非致死性心脏事件(再梗死、持续室性心动过速、室颤、心源性休克、严重心力衰竭)发生情况,用Kaplan Meier法和Cox比例风险模型比较生存率、发生率和风险度。结果 1 fQRS组与无fQRS组3年内非致死性心脏事件发生率分别是28.9%和12.2%(χ2=13.303,P=0.000)。在校正了年龄等混杂因素的影响后,f QRS组患者发生非致死性心脏事件的风险度(HR)为2.642,Wald=11.593,P=0.001。2 f QRS组1、2、3年累计生存率分别为93.1%、91.4%和88.6%,无f QRS组1、2、3年累计生存率分别为98.2%、97.0%和95.7%(χ2=5.276,P=0.022)。在调整了患者年龄等因素的作用后,f QRS组患者发生心源性死亡的HR为2.674,Wald=4.371,P=0.037。结论 fQRS波是评估AMI后患者预后的一项新的无创心电指标。

Objective To investigate the relationship between fragmented QRS complex( fQRS)and the prognosis of patients with acute myocardial infarction( AMI). Methods According to the presence or absence of fQRS in ECG,the enrolled 287 AMI patients were divided into fQRS group and non-f QRS group and their clinical data were collected. A follow-up of 1- 36 months was carried out focusing on the incidences of cardiac death and nonfatal cardiac events( reinfarction,sustained ventricular tachycardia,ventricular fibrillation,cardiogenic shock,severe heart failure). By Kaplan Meier method and Cox proportional hazard model,their survival rate,incidence,and risk degree were compared. Results( i) In fQRS group and non-f QRS group,the incidence of nonfatal cardiac events within three years was 28. 9% and 12. 2%,respectively,χ2= 13. 303,P = 0. 000. With influences of ages and other confounding factors adjusted,the hazard ratio( HR) of nonfatal cardiac events was 2. 642,Wald = 11. 593,P = 0. 001.( ii) The cumulative survival rates within one,two,and three years were 93. 1%,91. 4% and 88. 6% in fQRS group,respectively,while the number was 98. 2%,97. 0% and 95. 7% in non-f QRS group,respectively; χ2= 5. 276,P = 0. 022.With influences of ages and other confounding factors adjusted,HR of cardiac death was 2. 674,Wald = 4. 371,P = 0. 037. Conclusion f QRS complex proves to be a new non-invasive ECG index to evaluate the prognosis of AMI patients.