碎裂QRS波群在经皮冠状动脉介入治疗急性前壁心肌梗死病人中的预测价值

摘要

目的 探讨经皮冠状动脉介入治疗急性前壁心肌梗死病人出院时心电图碎裂QRS波群对预后的判断价值.方法 回顾性纳入了213例经皮冠状动脉介入治疗的急性前壁心肌梗死病人,根据病人出院前心电图是否存在碎裂QRS波群,将病人分为碎裂QRS波群组(107例)和非碎裂QRS波群组(106例).碎裂QRS波定义为标准12导联心电图至少存在对应冠状动脉供血区域2个或2个以上连续导联的QRS波群上存在多种RSR'波型(≥1个R'波,R波的顶部或S波的底部出现顿挫波),伴有或不伴有Q波.结果 两组平均随访时间对比差异无统计学意义(P=0.319).经过1年的临床随访,本研究主要复合终点事件发生率在两组间比较差异有统计学意义(P=0.001);全因病死率在碎裂QRS波群组为7.48％,在非碎裂QRS波群组为0.94％ (P =0.019);心源性病死率在碎裂QRS波群组和非碎裂QRS波群组分别为5.61％和0.94％ (P =0.098);随访期间两组再发性急性冠脉综合征发生率和冠状动脉血运重建率对比具有相似的发生率.心力衰竭发生率在两组之间也相似.结论 在经皮冠状动脉介入治疗急性前壁心肌梗死病人中,出院时心电图中存在碎裂QRS波的病人主要复合终点事件发生率明显高于非碎裂QRS波的病人,其中全因病死率在存在碎裂QRS波的病人中明显升高.%Objective To evaluate the prognostic value of fragmented QRS complexes in patients with acute anterior myocardial infarction treated with percutaneous coronary intervention.Methods A total of 213 patients with acute anterior myocardial infarction treated with percutaneous coronary intervention were included in this retrospective study.Patients were divided into 2 groups according to the presence or absence of fragmented QRS complex at discharge.Fragmented QRS complexes refer to various RSR' patterns (≥ 1 R' or notching of S wave or R wave) with or without Q wave in 2 or more contiguous leads corresponding to a major coronary artery territory on the routine 12-lead electrocardiograms (ECGs).Results The follow-up period was similar in both groups (P =0.319).During the 1-year follow-up,the incidence of major composite endpoint event was significant difference between the two groups in this study (P =0.001).The rate of all-cause death was 7.48％ for the fragmented QRS complex group and 0.94％ for the non-fragmented QRS complex group (P =0.019).Cardiac death rate was 5.61％ in the fragmented QRS complex group and 0.94％ in the non-fragmented QRS complex group(P =0.098).The incidence of acute coronary syndrome and coronary artery revascularization were similar between the two groups during 1-year follow-up.The incidence of heart failure was also similar between the two groups.Conclusion In patients with acute anterior myocardial infarction who underwent percutaneous coronary intervention,the incidence of major composite endpoint event was significantly higher in patients with fragmented QRS complex than those without fragmented QRS complex.The all-cause mortality rate was significantly increased in patients with fragmented QRS complex.