Clinical Trials Center, Cardiovascular Research Foundation, New York, NY, United States.
Clinical Trials Center, Cardiovascular Research Foundation, New York, NY, United States; Arrhythmia & Pacemaker Center, Department of Cardiology, St. Francis Hospital, Roslyn, NY, United States.
Int J Cardiol. 2018 Feb 15;253:20-24. doi: 10.1016/j.ijcard.2017.10.051.
QRS fragmentation (fQRS) is believed to reflect myocardial scar formation in patients with coronary disease. Whether early formation of fQRS in patients with ST-segment elevation myocardial infarction (STEMI) treated with percutaneous coronary intervention (PCI) is correlated with infarct size and prognosis is unknown. We assessed the prognostic value of fQRS at 60min post-PCI and its correlation with infarct size in patients with anterior STEMI managed with primary PCI.
The INFUSE-AMI trial enrolled 452 patients with anterior STEMI undergoing primary PCI. Electrocardiograms (ECGs) were performed at baseline and 60min post-PCI. Infarct size was evaluated using cardiac magnetic resonance imaging at 30days post-PCI. Target vessel failure (TVF) was defined as the composite of cardiac death, target vessel myocardial infarction, or ischemia-driven target vessel revascularization. Study groups were defined as patients with versus without fQRS at 60min post-PCI.
Out of 421 patients with ECG data 60min post-PCI, 68 patients (16.2%) had fQRS. Patients with versus without fQRS had similar baseline characteristics and infarct size (16.9%±8.7% vs. 16.1%±10.5%, p=0.62), but patients with fQRS had higher adjusted risk of 1-year TVF (adjusted HR 2.27, 95% CI 1.06-4.89, p=0.036) and a trend toward a higher risk of the composite cardiac death or target vessel myocardial infarction (9.0% vs. 4.1%, p=0.08) at 1year.
fQRS in patients with STEMI is associated with TVF but does not correlate with infarct size.
QRS 碎裂（fQRS）被认为反映了冠心病患者心肌瘢痕的形成。接受经皮冠状动脉介入治疗（PCI）的 ST 段抬高型心肌梗死（STEMI）患者的 fQRS 是否早期形成与梗死面积和预后相关尚不清楚。我们评估了 fQRS 在接受直接 PCI 治疗的前壁 STEMI 患者 PCI 后 60 分钟时的预后价值及其与梗死面积的相关性。
INFUSE-AMI 试验纳入了 452 例接受直接 PCI 的前壁 STEMI 患者。患者在基线和 PCI 后 60 分钟时进行心电图（ECG）检查。在 PCI 后 30 天使用心脏磁共振成像评估梗死面积。靶血管失败（TVF）定义为心脏死亡、靶血管心肌梗死或缺血驱动的靶血管血运重建的复合终点。研究组定义为 PCI 后 60 分钟时有无 fQRS 的患者。
在 421 例有 PCI 后 60 分钟心电图数据的患者中，有 68 例（16.2%）患者出现 fQRS。有 fQRS 与无 fQRS 的患者具有相似的基线特征和梗死面积（16.9%±8.7% vs. 16.1%±10.5%，p=0.62），但 fQRS 患者的 1 年 TVF 调整风险更高（调整后的 HR 2.27，95% CI 1.06-4.89，p=0.036），且在 1 年内发生复合终点心脏死亡或靶血管心肌梗死的风险有增高趋势（9.0% vs. 4.1%，p=0.08）。
STEMI 患者的 fQRS 与 TVF 相关，但与梗死面积无关。
