Zhang Ruoxi, Chen Shuyuan, Zhao Qi, Sun Meng, Yu Bo, Hou Jingbo
Department of Cardiology, The 2nd Affiliated Hospital of Harbin Medical University, Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, Harbin, Heilongjiang 150086, P.R. China.
Exp Ther Med. 2017 Jun;13(6):3231-3238. doi: 10.3892/etm.2017.4380. Epub 2017 Apr 25.
The present study aimed to investigate the in-hospital and long-term prognostic value of fragmented QRS complex (fQRS) for microvascular reperfusion and changes in left ventricular (LV) function in patients with ST elevation myocardial infarction (STEMI) who underwent primary percutaneous coronary intervention (PCI). A total of 216 patients with STEMI undergoing primary PCI were included in the current study. Patients were divided into two groups based on the presence (n=126) or absence (n=90) of fQRS following electrocardiograms (ECGs) on admission. Following primary PCI and follow up, patients were divided into four groups based on new onset, resolution, persistence and absence of fQRS. Major adverse cardiac events were defined to include cardiovascular death, arrhythmia, heart failure, reinfarction and target vessel revascularization. The percentage of patients with heart failure and microvascular reperfusion differed significantly between the fQRS(+) and fQRS(-) groups. Levels of N-terminal pro-brain natriuretic peptide (NT-proBNP), Peak creatine kinase-MB (CK-MB) and Troponin I levels were observed to be significantly higher in the fQRS(+) group compared with the fQRS(-) group. In univariate logistic regression analysis, left ventricular ejection fraction (LVEF), NT-proBNP, Troponin I, Peak CK-MB and microvascular reperfusion were found to be associated with fQRS. Multivariate analysis identified that LVEF, NT-proBNP, Troponin I and microvascular reperfusion may be independent predictors of fQRS. The presence of fQRS was demonstrated to be associated with left ventricular dysfunction at follow up assessments. The presence of fQRS was not only significantly associated with myocardial microvascular reperfusion and left ventricular function, but was also a prognostic marker in STEMI.
本研究旨在探讨碎裂QRS波群（fQRS）对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）患者微血管再灌注及左心室（LV）功能变化的院内及长期预后价值。本研究共纳入216例接受直接PCI的STEMI患者。根据入院时心电图（ECG）是否存在fQRS将患者分为两组，存在fQRS组（n = 126）和不存在fQRS组（n = 90）。在直接PCI及随访后，根据fQRS的新发、消失、持续存在及不存在情况将患者分为四组。主要不良心脏事件定义为包括心血管死亡、心律失常、心力衰竭、再梗死及靶血管血运重建。fQRS（+）组和fQRS（-）组之间心力衰竭和微血管再灌注患者的百分比差异显著。观察到fQRS（+）组N末端脑钠肽前体（NT-proBNP）、肌酸激酶同工酶（CK-MB）峰值和肌钙蛋白I水平显著高于fQRS（-）组。在单因素逻辑回归分析中，发现左心室射血分数（LVEF）、NT-proBNP、肌钙蛋白I、CK-MB峰值和微血管再灌注与fQRS相关。多因素分析确定LVEF、NT-proBNP、肌钙蛋白I和微血管再灌注可能是fQRS的独立预测因素。在随访评估中，fQRS的存在与左心室功能障碍相关。fQRS的存在不仅与心肌微血管再灌注和左心室功能显著相关，也是STEMI的一个预后标志物。
