碎裂QRS波群在经皮冠状动脉介入治疗急性前壁心肌梗死病人中的预测价值

doi:10.3969/j.issn.1006-7795.2017.03.027

首都医科大学学报 ›› 2017, Vol. 38 ›› Issue (3): 470-474.doi: 10.3969/j.issn.1006-7795.2017.03.027

碎裂QRS波群在经皮冠状动脉介入治疗急性前壁心肌梗死病人中的预测价值

高德全¹, 贾文芳¹, 谢亚闯¹, 刘明涛¹, 董新博¹, 方雪花¹, 李晓涛²

1. 首都医科大学附属北京良乡医院心内科, 北京 102401;
2. 武警北京市总队医院心内科, 北京 100027

收稿日期:2016-11-03 出版日期:2017-05-21 发布日期:2017-06-14
通讯作者: 李晓涛 E-mail:15801095812@163.com

Prognostic value of fragmented QRS complexes in patients with acute anterior myocardial infarction treated with percutaneous coronary intervention

Gao Dequan¹, Jia Wenfang¹, Xie Yachuang¹, Liu Mingtao¹, Dong Xinbo¹, Fang Xuehua¹, Li Xiaotao²

1. Department of Cardiology, Beijing Liangxiang Hospital, Capital Medical University, Beijing 102401, China;
2. Department of Cardiology, Beijing Armed Police Corps Hospital, Beijing 100027, China

Received:2016-11-03 Online:2017-05-21 Published:2017-06-14

摘要/Abstract

摘要： 目的探讨经皮冠状动脉介入治疗急性前壁心肌梗死病人出院时心电图碎裂QRS波群对预后的判断价值。方法回顾性纳入了213例经皮冠状动脉介入治疗的急性前壁心肌梗死病人，根据病人出院前心电图是否存在碎裂QRS波群，将病人分为碎裂QRS波群组（107例）和非碎裂QRS波群组（106例）。碎裂QRS波定义为标准12导联心电图至少存在对应冠状动脉供血区域2个或2个以上连续导联的QRS波群上存在多种RSR'波型（≥ 1个R'波，R波的顶部或S波的底部出现顿挫波），伴有或不伴有Q波。结果两组平均随访时间对比差异无统计学意义（P=0.319）。经过1年的临床随访，本研究主要复合终点事件发生率在两组间比较差异有统计学意义（P=0.001）；全因病死率在碎裂QRS波群组为7.48%，在非碎裂QRS波群组为0.94%（P=0.019）；心源性病死率在碎裂QRS波群组和非碎裂QRS波群组分别为5.61%和0.94%（P=0.098）；随访期间两组再发性急性冠脉综合征发生率和冠状动脉血运重建率对比具有相似的发生率。心力衰竭发生率在两组之间也相似。结论在经皮冠状动脉介入治疗急性前壁心肌梗死病人中，出院时心电图中存在碎裂QRS波的病人主要复合终点事件发生率明显高于非碎裂QRS波的病人，其中全因病死率在存在碎裂QRS波的病人中明显升高。

关键词: 碎裂QRS波群, 急性前壁心肌梗死, 经皮冠状动脉介入治疗

Abstract: Objective To evaluate the prognostic value of fragmented QRS complexes in patients with acute anterior myocardial infarction treated with percutaneous coronary intervention.Methods A total of 213 patients with acute anterior myocardial infarction treated with percutaneous coronary intervention were included in this retrospective study. Patients were divided into 2 groups according to the presence or absence of fragmented QRS complex at discharge. Fragmented QRS complexes refer to various RSR' patterns (≥ 1 R' or notching of S wave or R wave) with or without Q wave in 2 or more contiguous leads corresponding to a major coronary artery territory on the routine 12-lead electrocardiograms (ECGs).Results The follow-up period was similar in both groups (P=0.319). During the 1-year follow-up, the incidence of major composite endpoint event was significant difference between the two groups in this study (P=0.001). The rate of all-cause death was 7.48% for the fragmented QRS complex group and 0.94% for the non-fragmented QRS complex group (P=0.019). Cardiac death rate was 5.61% in the fragmented QRS complex group and 0.94% in the non-fragmented QRS complex group(P=0.098). The incidence of acute coronary syndrome and coronary artery revascularization were similar between the two groups during 1-year follow-up. The incidence of heart failure was also similar between the two groups.Conclusion In patients with acute anterior myocardial infarction who underwent percutaneous coronary intervention, the incidence of major composite endpoint event was significantly higher in patients with fragmented QRS complex than those without fragmented QRS complex. The all-cause mortality rate was significantly increased in patients with fragmented QRS complex.

Key words: fragmented QRS complex, acute anterior myocardial infarction, percutaneous coronary intervention

中图分类号:

R542.2⁺2

高德全, 贾文芳, 谢亚闯, 刘明涛, 董新博, 方雪花, 李晓涛. 碎裂QRS波群在经皮冠状动脉介入治疗急性前壁心肌梗死病人中的预测价值[J]. 首都医科大学学报, 2017, 38(3): 470-474.

Gao Dequan, Jia Wenfang, Xie Yachuang, Liu Mingtao, Dong Xinbo, Fang Xuehua, Li Xiaotao. Prognostic value of fragmented QRS complexes in patients with acute anterior myocardial infarction treated with percutaneous coronary intervention[J]. Journal of Capital Medical University, 2017, 38(3): 470-474.

参考文献

[1] Friedman P L, Fenoglio J J, Wit A L. Time course for reversal of electrophysiological and ultrastructural abnormalities in subendocardial Purkinje fibers surviving extensive myocardial infarction in dogs[J]. Circ Res, 1975, 36(1):127-144.
[2] Das M K, Saha C, El Masry H, et al. Fragmented QRS on a 12-lead ECG:a predictor of mortality and cardiac events in patients with coronary artery disease[J]. Heart Rhythm, 2007, 4(11):1385-1392.
[3] Das M K, Khan B, Jacob S, et al. Significance of a fragmented QRS complex versus a Q wave in patients with coronary artery disease[J]. Circulation, 2006,113(21):2495-2501.
[4] Das M K, Zipes D P. Fragmented QRS:a predictor of mortality and sudden cardiac death[J]. Heart Rhythm,2009, 6:8-14.
[5] Flowers N C, Horan L G, Thomas J R, et al. The anatomic basis for highfrequency components in the electrocardiogram[J]. Circulation, 1969,39(4):531-539.
[6] Jain R, Singh R, Yamini S, et al. Fragmented ECG as a risk marker in cardiovascular diseases[J]. Curr Cardiol Rev, 2014, 10(3):277-286.
[7] Morita H, Kusano K F, Miura D, et al. Fragmented QRS as a marker of conduction abnormality and a predictor of prognosis of Brugada syndrome[J]. Circulation, 2008, 118(17):1697-1704.
[8] Das M K, Suradi H, Maskoun W, et al. Fragmented wide QRS on a 12-lead ECG:a sign of myocardial scar and poor prognosis[J]. CircArrhythmElectrophysiol, 2008, 1(4):258-268.
[9] Michael M A, El Masry H, Khan B R, et al. Electrocardiographic signs of remote myocardial infarction[J]. ProgCardiovasc Dis, 2007, 50(3):198-208.
[10] Guo R, Zhang J, Li Y, et al. Prognostic significance of fragmented QRS in patients with non-ST elevation myocardial infarction:results of a 1-year, singlecenter follow-up[J]. Herz, 2012,37(7):789-795.
[11] Akbarzadeh F, Pourafkari L, Ghaffari S, et al. Predictive value of the fragmented QRS complex in 6 month mortality and morbidity following acute coronary syndrome[J]. Int J Gen Med, 2013, 6:399-404.
[12] Pietrasik G, Goldenberg I, Zdzienicka J, et al. Prognostic significance of fragmented QRS complex for predicting the risk of recurrent cardiac events in patients with Q wave myocardial infarction[J]. Am J Cardiol, 2007, 100(4):583-586.
[13] Brenyo A, Pietrasik G, Barsheshet A, et al. QRS fragmentation and the risk of sudden cardiac death in MADIT Ⅱ. J Cardiovasc Electrophysiol, 2012; 23(12):1343-1348.
[14] Canga A, Kocaman S A, Durakoğlugil M E, et al. Relationship between fragmented QRS complexes and left ventricular systolic and diastolic functions[J]. Herz, 2013, 38(6):665-670.
[15] Ari H, Cetinkaya S, Ari S, et al. The prognostic significance of a fragmented QRS complex after primary percutaneous coronary intervention[J]. Heart Vessels, 2012, 27(1):20-28.
[16] Korhonen P, Husa T, Konttila T, et al. Fragmented QRS in prediction of cardiac deaths and heart failure hospitalizations after myocardial infarction[J]. Ann Noninvasive Electrocardiol, 2010, 15(2):130-137.
[17] Uslu N, Gul M, Cakmak H A, et al. The assessment of relationship between fragmented QRS complex and left ventricular wall motion score index in patients with ST elevation myocardial infarction who underwent primary percutaneous coronary intervention[J]. Ann Noninvasive Electrocardiol, 2015, 20(2):148-157.
[18] Güngör B, Özcan K S, Karataş M B, et al. Prognostic value of QRS fragmentation in patients with acute myocardial infarction:a Meta-analysis[J]. Ann Noninvasive Electrocardiol, 2016, 21(6):604-612.

碎裂QRS波群在经皮冠状动脉介入治疗急性前壁心肌梗死病人中的预测价值

Prognostic value of fragmented QRS complexes in patients with acute anterior myocardial infarction treated with percutaneous coronary intervention

PDF

可视化

被引次数

摘要/Abstract

引用本文

使用本文

参考文献

相关文章 6

编辑推荐

Metrics

本文评价

[1]	孙昊, 郑美丽, 郭宗生, 张智勇, 李晓涛. 左心室收缩功能对经皮冠状动脉介入治疗的急性下壁ST段抬高型心肌梗死患者预后的影响[J]. 首都医科大学学报, 2022, 43(2): 305-310.
[2]	郝鹏, 冯斯婷, 甄雷, 王晓, 王春梅, 聂绍平. SYNTAX II评分对急性ST段抬高型心肌梗死患者直接PCI术后无复流的预测价值[J]. 首都医科大学学报, 2019, 40(5): 744-748.
[3]	王国忠, 华琦, 柳子静, 郝明辉, 徐荣, 张利彬, 陈文明, 郭金成. 基层医院通过微信院前激活导管室对急性ST段抬高型心肌梗死病人再灌注时间的影响[J]. 首都医科大学学报, 2017, 38(3): 391-396.
[4]	王长华;陈韵岱;杨新春;王乐丰;王红石;孙志军;刘宏斌;陈练. 女性患者急诊冠状动脉介入后无复流的独立预测因素[J]. 首都医科大学学报, 2012, 33(4): 432-436.
[5]	许晓晗;张维君;周玉杰;周志明;马涵英;胡宾;康云鹏;雒芳芳. 曲美他嗪对PCI术相关心肌损伤及术后再发心绞痛症状的临床研究[J]. 首都医科大学学报, 2012, 33(4): 457-461.
[6]	郭金成;华琦;刘力松;姚立云;李康;张学坤;万云高;张立新;张海滨. 经皮穿刺冠状动脉介入疗法的非心脏并发症的诊治[J]. 首都医科大学学报, 2005, 26(1): 84-86.