Dinakrisma Anastasia Asylia, Wijaya Ika Prasetya, Nasution Sally Aman, Dewiasty Esthika
Departement of Internal Medicine, Faculty of Medicine, Universitas Indonesia.
Acta Med Indones. 2019 Jan;51(1):3-9.
some studies show fragmanted QRS (fQRS) as a marker of myocardial scar, ventricular arrhythmia, ventricular remodelling and worse coronary collaterals flow, which can increase the incidence of major adverse cardiac event (MACE) after infarction. This study aimed to identify the role of fQRS as one of the risk factors for MACE (cardiac death and reinfarction) in acute coronary syndrome patients within 30 days observation.
a cohort retrospective study was conducted using secondary data of acute coronary syndrome patients at Intensive Cardiac Care Unit Cipto Mangunkusumo Hospital from July 2015 to October 2017. Multivariate analysis were done by using logistic regression with GRACE score (moderate and high risk), low eGFR (< 60 ml/min), low LVEF (< 40%), diabetes mellitus, age more than 45 years and hypertension as confounding factors.
three hundred and fifty three (353) subjects were included. Fragmented QRS was found in 60,9 % subjects. It was more frequent in inferior leads (48.8% ) with mean onset of 34 hours. Major adverse cardiac events were higher in fQRS vs. non-fQRS group (15.8% vs. 5.8 %). Bivariate analysis showed higher probability of 30 days MACE in fQRS group (RR 2.72; 95%CI 1.3 -5.71p=0.08). Multivariate analysis revealed adjusted RR of 2.79 (95% CI: 1.29 - 4.43, p<0.05). Low eGFR was a potential confounder in this study.
persistent fQRS developed in ACS during hospitalization is an independent predictor of 30 days MACE cardiac death and re-infarction.
一些研究表明，碎裂QRS波（fQRS）可作为心肌瘢痕、室性心律失常、心室重构及较差的冠状动脉侧支血流的标志物，这会增加心肌梗死后主要不良心脏事件（MACE）的发生率。本研究旨在确定fQRS作为急性冠状动脉综合征患者30天观察期内MACE（心源性死亡和再梗死）危险因素之一的作用。
采用2015年7月至2017年10月间Cipto Mangunkusumo医院心脏重症监护病房急性冠状动脉综合征患者的二次数据进行队列回顾性研究。多因素分析采用逻辑回归，将GRACE评分（中、高危）、低估算肾小球滤过率（eGFR，<60 ml/min）、低左心室射血分数（LVEF，<40%）、糖尿病、年龄超过45岁和高血压作为混杂因素。
纳入353名受试者。60.9%的受试者发现有碎裂QRS波。下壁导联更常见（48.8%），平均出现时间为34小时。fQRS组的主要不良心脏事件高于非fQRS组（15.8%对5.8%）。二元分析显示fQRS组30天MACE的可能性更高（相对危险度2.72；95%置信区间1.3 - 5.71，p = 0.08）。多因素分析显示校正后的相对危险度为2.79（95%置信区间：1.29 - 4.43，p<0.05）。低eGFR是本研究中的一个潜在混杂因素。
住院期间急性冠状动脉综合征患者出现的持续性fQRS是30天心源性死亡和再梗死MACE的独立预测因素。
