Tanriverdi Zulkif, Dursun Huseyin, Simsek Mustafa Aytek, Unal Baris, Kozan Omer, Kaya Dayimi
Clinic of Cardiology, Idil State Hospital, Sirnak, Turkey.
Department of Cardiology, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey.
Ann Noninvasive Electrocardiol. 2015 Nov;20(6):578-85. doi: 10.1111/anec.12265. Epub 2015 Feb 2.
QRS fragmentation (fQRS) and QRS distortion were separately shown to be related to increased cardiovascular mortality and morbidity. To our knowledge, no study so far evaluated both parameters together in ST segment elevation myocardial infarction (STEMI). The main goal of our study is to find out if fQRS and QRS distortion can help us to determine high-risk STEMI patients, and the success of reperfusion.
Two hundred forty-eight eligible patients with acute STEMI that underwent coronary angiography consecutively between January 1, 2009, and July 1, 2011, were enrolled in this study. Twelve-lead electrocardiography (ECG) of the patients taken in the first 48 hours were analyzed. Patients with fQRS formed group 1, without fQRS formed group 2; with QRS distortion formed group 3, and without QRS distortion formed group 4.
Group 1 have lower left ventricular ejection fraction (LVEF; P < 0.001), higher maximum troponin levels (P < 0.001), lower ST segment resolution (P < 0.001), more frequent proximal lesions (P < 0.001) when compared to group 2. Similar findings were observed in group 3 in comparison to group 4. Group 1 had also more frequent three vessels disease (P < 0.001), and higher rates of failed thrombolysis (P < 0.001). In-hospital mortality was found to be higher in group 1 and group 3.
fQRS and QRS distortion may be useful for identifying patients at higher cardiac risk. fQRS can foresee thrombolytic therapy failure and three vessels disease whereas QRS distortion does not possess such quality. These findings may guide the physician deciding initial treatment modality in STEMI.
QRS波碎裂（fQRS）和QRS波形态异常分别被证明与心血管疾病死亡率和发病率增加有关。据我们所知，目前尚无研究在ST段抬高型心肌梗死（STEMI）中同时评估这两个参数。我们研究的主要目的是确定fQRS和QRS波形态异常是否有助于我们识别高危STEMI患者以及再灌注的成功率。
本研究纳入了2009年1月1日至2011年7月1日期间连续接受冠状动脉造影的248例符合条件的急性STEMI患者。分析患者在最初48小时内的12导联心电图（ECG）。有fQRS的患者形成第1组，无fQRS的患者形成第2组；有QRS波形态异常的患者形成第3组，无QRS波形态异常的患者形成第4组。
与第2组相比，第1组的左心室射血分数（LVEF）较低（P < 0.001），肌钙蛋白最高水平较高（P < 0.001），ST段回落较低（P < 0.001），近端病变更常见（P < 0.001）。与第4组相比，第3组也有类似的发现。第1组三支血管病变也更常见（P < 0.001），溶栓失败率更高（P < 0.001）。第1组和第3组的院内死亡率较高。
fQRS和QRS波形态异常可能有助于识别心脏风险较高的患者。fQRS可以预测溶栓治疗失败和三支血管病变，而QRS波形态异常则不具备此特性。这些发现可能指导医生决定STEMI的初始治疗方式。
