Department of Cardiology, Seyyed-al-Shohada Heart Center, Urmia University of Medical Science, Urmia, Iran.
Tehran University of Medical Sciences, Tehran, Iran.
Herz. 2021 Jun;46(3):285-290. doi: 10.1007/s00059-020-04940-0. Epub 2020 May 26.
Several factors and risk stratification tools have been studied to determine the prognosis of acute coronary syndrome. Fragmented QRS (fQRS) is a marker of myocardial scar and its prognostic role has recently been demonstrated. The present study aimed to investigate the association between the presence of fQRS in electrocardiogram and the prognosis of ST-segment elevation and non-ST-segment elevation myocardial infarction (STEMI and NSTEMI).
A total of 661 patients with myocardial infarction (MI) were enrolled in a retrospective study. Based on the presence of fQRS in admission electrocardiogram, patients were divided into two groups. All patients were followed up for 6 months, and all major adverse cardiovascular events (MACE) were recorded.
The mean age of patients was 61.3 ± 1.2 years, and 71.7% were male. In the acute phase, the detection rates of regional wall motion abnormality and aortic valve insufficiency were higher in positive fQRS compared to negative fQRS group (p = 0.003). The incidence of total MACE was significantly higher in the positive fQRS compared to the negative fQRS group among all patients and in both STEMI and NSTEMI subgroups (p < 0.001). Based on multivariate analysis, the presence of fQRS and hypertension were the strongest predictors of total MACE at 6‑month follow-up (odds ratio [OR] = 5.929; 95% confidence interval [CI] = 3.620-9.709; p < 0.001 and OR = 2.220; 95% CI = 1.390-3.547; p < 0.001, respectively).
Regardless of the type of MI, it was found that the presence of fQRS on admission electrocardiogram can be implemented in risk stratification tools in patients with acute MI.
已经有许多因素和风险分层工具被研究用于确定急性冠状动脉综合征的预后。碎裂 QRS 波（fQRS）是心肌瘢痕的标志物，其预后作用最近已得到证实。本研究旨在探讨心电图中 fQRS 的存在与 ST 段抬高型和非 ST 段抬高型心肌梗死（STEMI 和 NSTEMI）患者预后之间的关系。
共纳入 661 例心肌梗死（MI）患者进行回顾性研究。根据入院心电图中 fQRS 的存在，将患者分为两组。所有患者均随访 6 个月，并记录所有主要不良心血管事件（MACE）。
患者的平均年龄为 61.3±1.2 岁，71.7%为男性。在急性期，阳性 fQRS 组比阴性 fQRS 组的区域性壁运动异常和主动脉瓣关闭不全的检出率更高（p=0.003）。所有患者、STEMI 和 NSTEMI 亚组中，阳性 fQRS 组的总 MACE 发生率明显高于阴性 fQRS 组（p<0.001）。多变量分析显示，fQRS 的存在和高血压是 6 个月随访时总 MACE 的最强预测因素（优势比 [OR]分别为 5.929；95%置信区间 [CI]为 3.620-9.709；p<0.001 和 OR 分别为 2.220；95%CI 为 1.390-3.547；p<0.001）。
无论 MI 类型如何，入院心电图中 fQRS 的存在可用于急性 MI 患者的风险分层工具。
