University of Alberta, Edmonton, Canada.
Am J Cardiol. 2010 Sep 1;106(5):630-4. doi: 10.1016/j.amjcard.2010.04.013.
The prognostic value of myocardial infarct size estimation by QRS scoring in patients with ST-segment elevation myocardial infarction (STEMI) who undergo primary percutaneous coronary intervention (PCI) is unclear. The standard 32-point Selvester QRS score on the discharge electrocardiogram (each point approximately 3% left ventricular mass) was calculated in 4,113 patients with STEMI who underwent primary PCI and survived to hospital discharge in the APEX-AMI trial. QRS scores were divided into tertiles, i.e., < or =3 (<10% myocardium), 4 to 7 (10% to 21% myocardium), and > or =8 (>21% myocardium). Adjusted associations between QRS score and 90-day outcomes (death and composite of death/congestive heart failure (CHF)/shock) were examined. Higher QRS scores were associated with male gender, higher heart rate, worse Killip class, noninferior infarct location, greater ST-segment deviation, and longer times to reperfusion. Higher QRS scores were also associated with impaired culprit artery flow before and after PCI and more frequent multivessel disease. Adverse outcomes occurred more often in patients with higher QRS scores (90-day death: 1.9%, QRS score 0 to 3; 3.4%, 4 to 7; 4.9%, > or =8; 90-day death/shock/CHF: 4.5%, 0-3; 7.8%, 4 to 7; 12.1%, > or =8). After multivariable adjustment, patients with higher QRS scores remained more likely to develop an adverse outcome versus those with QRS scores < or =3 (score 4 to 7, hazard ratios [HR] for death 2.08, 95% confidence interval [CI] 1.26 to 3.41; HR for death/CHF/shock 2.00, 95% CI 1.26 to 3.17; score > or =8, HR for death 2.57, 95% CI 1.56 to 4.24, HR for death/CHF/shock 2.93, 95% CI 1.84 to 4.67). In conclusion, infarct size as estimated by QRS scoring at hospital discharge is an independent and prognostically relevant metric in patients with STEMI undergoing primary PCI.
在接受直接经皮冠状动脉介入治疗（PCI）的 ST 段抬高型心肌梗死（STEMI）患者中，通过 QRS 评分估计心肌梗死面积的预后价值尚不清楚。在 APEX-AMI 试验中，对 4113 例接受直接 PCI 并存活至出院的 STEMI 患者，在出院时的标准 32 分 Selvester QRS 评分（每点约为 3%的左心室质量）进行了计算。QRS 评分分为三分位数，即 <或=3（<10%心肌）、4 至 7（10%至 21%心肌）和 >或=8（>21%心肌）。检查了 QRS 评分与 90 天结局（死亡和死亡/充血性心力衰竭（CHF）/休克的复合）之间的调整关联。较高的 QRS 评分与男性、较高的心率、较差的 Killip 分级、非劣效性梗死部位、较大的 ST 段偏移和再灌注时间较长有关。较高的 QRS 评分也与 PCI 前后罪犯动脉血流受损以及更频繁的多血管疾病有关。较高 QRS 评分的患者不良结局更为常见（90 天死亡率：1.9%，QRS 评分 0 至 3；3.4%，4 至 7；4.9%，>或=8；90 天死亡率/休克/CHF：4.5%，0-3；7.8%，4 至 7；12.1%，>或=8）。在多变量调整后，与 QRS 评分 <或=3 的患者相比，QRS 评分较高的患者发生不良结局的可能性更高（评分 4 至 7，死亡的 HR 为 2.08，95%CI 为 1.26 至 3.41；死亡/CHF/休克的 HR 为 2.00，95%CI 为 1.26 至 3.17；评分 >或=8，死亡的 HR 为 2.57，95%CI 为 1.56 至 4.24，死亡/CHF/休克的 HR 为 2.93，95%CI 为 1.84 至 4.67）。总之，在接受直接 PCI 的 STEMI 患者中，出院时通过 QRS 评分估计的梗死面积是一个独立的、具有预后相关性的指标。
