摘要
This study is aimed to investigate the clinical significance and the short-term prognostic value of frag- mented QRS （fQRS） for patients with acute myocardial infarction （AMI）. Three hundred patients with AMI were tested with retrospective analysis on the patients＇ clinical information, hospitalized treatment, fQRS onset time, location of lesions, and other relevant data, in order to assess the relationship between the presence of fQRS and its prognosis. The rates of malignant cardiac arrhythmia, left ventricular systolic dysfunction （LVSD）, and mortality in the positive fQRS group were 13.6%, 29.2%, and 23.7%, respectively, with all showing a p value 〈0.05. For the ST segment elevation myocardial infarction （STEMI） subgroup, all the rates showed significant differences with a p value 〈0.01, while for the non-STEMI （NSTEMI） subgroup showed no significant differences. In patients with a positive fQRS, there were no differences in malignant cardiac arrhythmia between patients with and without percutaneous coronary in- tervention （PCI） （p〉0.05）. As for the LVSD and mortality, the p values between patients with and without PCI were 0.031 and 0.000, respectively, suggesting statistical significance. The results imply that AMI patients with positive fQRS especially for the patients with STEMI had higher rates of malignant cardiac arrhythmia, LVSD, and mortality than the non-fQRS group. Patients of AMI with positive fQRS, who underwent early revascularization, could lower the incidence of the cardiovascular event. In addition, the presence of fQRS could be used as an indication of early in- tervention treatment for patients.
研究目的:探讨碎裂QRS波对急性心肌梗死患者的短期预后评估的价值,及其对ST段抬高和非ST段抬高型心肌梗死(STEMI和NSTEMI)患者不同的预测价值。创新要点:证实了碎裂QRS波对急性心肌梗死尤其是ST段抬高型心肌梗死的短期预后价值,对早期再灌注治疗有指导意义。研究方法:通过对碎裂QRS波发生及持续时间的详细记录(见图1、2),评价出现碎裂QRS波的STEMI及NSTEMI患者住院期间发生恶性心律失常、泵功能衰竭及住院死亡的风险(见图3;表3–5),并观察早期经皮冠状动脉介入治疗(PCI)对预后的不同影响(见表6)。重要结论:1.急性心肌梗死(尤其是STEMI)患者心电图出现碎裂QRS波短期内易发生恶性心律失常、左心室功能不全及死亡;2.对出现碎裂QRS波的急性心肌梗死患者,早期PCI再灌注治疗可改善患者短期预后。
基金
Project supported by the National Science & Technology Pillar Program during the 12th Five-Year Plan Period(No.2011BAI11B06),China
