Dursun Huseyin, Tanriverdi Zulkif, Gul Sefa, Colluoglu Tugce, Kaya Dayimi
aDepartment of Cardiology, Faculty of Medicine, Dokuz Eylul University, Izmir bClinic of Cardiology, Idil State Hospital, Sirnak, Turkey.
Coron Artery Dis. 2015 Dec;26(8):692-8. doi: 10.1097/MCA.0000000000000299.
The aim of this study is to determine whether the presence of fragmented QRS (fQRS) and QRS distortion on admission ECG can be used to predict the success of treatment before beginning thrombolytic therapy (TT).
Two hundred and three eligible patients with acute ST elevation myocardial infarction who received TT consecutively between 1 January 2009 and 1 July 2013 were enrolled. The presence of fQRS and QRS distortion was analyzed at admission ECG. The electrocardiographic criteria of reperfusion were defined as 50% or more of ST resolution (STR), whereas the angiographic criteria of reperfusion were defined as thrombolysis in myocardial infarction 2/3 flow in the infarct-related artery.
fQRS was detected in 63 (31%) patients. Compared with patients with non-fQRS, STR was lower (46.1±17.7 vs. 73.6±20.9, respectively; P<0.001), thrombolysis failure was higher (44.4 vs. 9.3%, respectively; P<0.001), and thrombolysis in myocardial infarction 0/1 flow was more common (39.7 vs. 10.7%, respectively; P<0.001) in patients with fQRS. Higher numbers of fQRS derivations were significantly related to low percentages of STR (r=-0.615, P<0.001). In predicting occluded infarct-related artery, we found no difference between the negative predictive values of fQRS and inadequate STR after TT (89.3 vs. 95.1%; P>0.05). However, there was no relationship between QRS distortion and failed thrombolysis.
fQRS was detected in just 31% of the patients, but we found that it can be used to predict thrombolytic failure. Patients who have this simple marker on admission ECG may be directed to percutaneous interventions as a first-line therapy without any delay.
本研究旨在确定入院心电图上碎裂QRS波（fQRS）和QRS波形态改变的出现是否可用于预测溶栓治疗（TT）开始前的治疗成功率。
纳入2009年1月1日至2013年7月1日期间连续接受TT治疗的203例符合条件的急性ST段抬高型心肌梗死患者。分析入院心电图上fQRS和QRS波形态改变的情况。再灌注的心电图标准定义为ST段回落（STR）≥50%，而血管造影再灌注标准定义为梗死相关动脉心肌梗死溶栓2/3级血流。
63例（31%）患者检测到fQRS。与无fQRS的患者相比，fQRS患者的STR较低（分别为46.1±17.7与73.6±20.9；P<0.001），溶栓失败率较高（分别为44.4%与9.3%；P<0.001），心肌梗死溶栓0/1级血流更常见（分别为39.7%与10.7%；P<0.001）。fQRS导联数越多与STR百分比越低显著相关（r=-0.615，P<0.001）。在预测梗死相关动脉闭塞方面，我们发现TT后fQRS的阴性预测值与STR不足之间无差异（89.3%与95.1%；P>0.05）。然而，QRS波形态改变与溶栓失败之间无相关性。
仅31%的患者检测到fQRS，但我们发现它可用于预测溶栓失败。入院心电图上有此简单标志物的患者可直接接受经皮介入治疗作为一线治疗，无需任何延迟。
