2019 年第 6 期 第 14 卷

心电图碎裂QRS波群对心肌梗死近期预后的预测价值

Predictive value of fragmented QRS complexes for short-term prognosis in patients with acute myocardial infarction

作者：李敏单世富王晓贾淑杰辛伟池喆周芸聂绍平

英文作者：

单位：100029首都医科大学附属北京安贞医院心内科（李敏、贾淑杰、辛伟、池喆、周芸），急诊危重症中心（王晓、聂绍平）；750001银川，宁夏回族自治区人民医院心内科（单世富）

英文单位：

关键词：急性心肌梗死；碎裂QRS波群；主要不良心血管事件

英文关键词：

• 摘要：

• 【摘要】目的    探讨心电图碎裂QRS波群(fQRS)对急性心肌梗死（AMI）患者近期临床预后的预测价值。方法    回顾性分析2014年1月1日至12月31日首都医科大学附属北京安贞医院入院的新发病24 h之内的AMI患者的临床资料，共纳入1 020例，包括fQRS患者507例、非fQRS患者513例。记录患者基本资料、入院实验室检查、心电图、超声心动图、冠状动脉造影等，出院后6个月电话随访主要不良心血管事件（MACE）发生情况。分析心电图fQRS与AMI临床资料的关系，以及心电图fQRS及相关临床资料与随访期间MACE的关系。结果    本组心电图出现fQRS患者占比为49.7%（507/1 020）。fQRS组陈旧心肌梗死比例明显高于非fQRS组［18.9%（96/507）比12.1%（62/513）］（P＝0.002）。fQRS组心功能Killip分级1级较非fQRS组少，2、3、4级比例较多，组间比较差异有统计学意义（P＝0.014）。fQRS组血清肌酐、同型半胱氨酸、红细胞分布宽度标准差、红细胞分布宽度变异系数明显高于非fQRS组，血小板计数明显低于非fQRS组，差异均有统计学意义（均P＜0.05)。fQRS组出院后6个月血运重建发生率明显高于非fQRS组［9.1%（46/507）比5.8%（30/513）］（P＝0.049)。Logistic回归分析显示，年龄（比值比＝1.024，P＜0.001)、入院时舒张压（比值比＝1.015，P＝0.009）、肌酸激酶（比值比＝1.000，P＝0.022）、陈旧心肌梗死（比值比＝1.692，P＝0.003）是心电图fQRS的独立预测因素。右冠状动脉狭窄（比值比＝1.687，P＝0.003）、入院收缩压降低（比值比＝0.982，P＜0.001）、血清尿素水平增加（比值比＝1.130，P＝0.001）、心电图出现fQRS（比值比＝1.276，P＝0.008）是随访期间发生MACE的独立预测因素。结论    心电图fQRS在AMI患者中普遍存在。心电图fQRS提示近期血运重建发生率升高。fQRS的独立预测因素包括年龄、舒张压、肌酸激酶、陈旧心肌梗死。AMI患者出现fQRS预示近期预后不佳，随访心血管事件增加。

• 【Abstract】Objective    To explore the value of fragmented QRS complexes(fQRS) in prediction of short-term prognosis in patients with acute myocardial infarction（AMI）. Methods    Clinical data of 1 020 new-onset（＜24 h） AMI patients including 507 patients with fQRS and 513 patients without fQRS admitted to Beijing Anzhen Hospital, Capital Medical University from January 1st to December 31st, 2014 were retrospectively analyzed. Basic information, laboratory examination, electrocardiogram, echocardiogram and coronary angiography results were recorded. Major adverse cardiovascular events（MACE） were observed in 6 months after discharge. Relations among fQRS, clinical indicators of AMI and incidence of MACE were analyzed. Results    Incidence of fQRS in electrocardiogram was 49.7%（507/1 020）. Rate of old myocardial infarction in fQRS patients was significantly higher than that in non-fQRS patients［18.9%（96/507） vs 12.1%（62/513）］（P＝0.002）. Patients with fQRS had lower rate of Killip grade 1 and higher rates of Killip grade 2, 3, 4（P＝0.014）. Levels of serum creatinine, homocysteine, erythrocyte distribution width-standard deviation and erythrocyte distribution width-coefficient of variation in fQRS patients were significantly higher and platelet count was significantly lower than those in non-fQRS patients（all P＜0.05). The 6-month incidence of MACE in fQRS patients was significantly higher than that in non-fQRS patients［9.1%（46/507） vs 5.8%（30/513）］（P＝0.049). Logistic regression showed that age（odds ratio＝1.024， P＜0.001), diastolic blood pressure at admission（odds ratio＝1.015， P＝0.009）, serum creatine kinase（odds ratio＝1.000， P＝0.022） and old myocardial infarction（odds ratio＝1.692， P＝0.003） were independent predictive factors of fQRS. Right coronary artery stenosis（odds ratio＝1.687， P＝0.003）, reduced systolic blood pressure at admission（odds ratio＝0.982， P＜0.001）, elevated serum urea level（odds ratio＝1.130， P＝0.001） and fQRS（odds ratio＝1.276， P＝0.008） were independent predictive factors of short-term MACE. Conclusions    There is a high prevalence of fQRS in AMI patients. Age, diastolic blood pressure, creatine kinase and old myocardial infarction are independent predictors of fQRS; fQRS indicates poor short-term prognosis and more adverse cardiovascular events.