碎裂QRS波与急性冠脉综合征患者冠脉病变及短期预后的相关性研究  

Correlation between the fragmented QRS complex and coronary artery lesions and short-term prognosis in patients with acute coronary syndrome

作　　者：刘欢 高敏[1] 王延林[1] 王慕秋[1] 狄欣欣[1] Liu Huan;Gao Min;Wang Yanlin;Wang Muqiu;Di Xinxin(Department of Cardiology,Anhui Provincial Hospital,Hefei 230001,China)

机构地区：[1]安徽医科大学附属省立医院、安徽省立医院心血管内科,合肥230001

出　　处：《中国临床保健杂志》2020年第3期419-423,共5页Chinese Journal of Clinical Healthcare

基　　金：安徽省自然科学基金项目(1708085MH227)。

摘　　要：目的探讨碎裂QRS波(fQRS)与急性冠脉综合征(ACS)患者冠脉病变、短期内不良心血管事件间的相关性。方法回顾性分析361例ACS患者的实验室检查、心电图、冠脉造影结果等临床资料,并借助Gensini评分、SYNTAX评分定量评估冠脉病变严重程度。根据心电图上是否存在fQRS,分为fQRS(+)和fQRS(-)组,出院后均随访6个月,记录主要不良心血管事件(MACE)的发生情况。比较两组在冠脉病变、MACE的发生上是否存在差异,并寻找影响ACS患者短期预后的危险因素。结果共142例在心电图出现fQRS,其检出率为39.3%(142/361),STEMI、NSTEMI患者的fQRS检出率明显高于UA患者(P<0.05)。与fQRS(-)组相比,fQRS(+)组患者三支病变多见,Gensini评分、SYNTAX评分更高,6个月内MACE发生率更高(48.5%比13.2%,P<0.05),且以非计划再次血运重建、心力衰竭及再发心绞痛事件为主。多因素logistic回归分析发现fQRS、Gensini评分、SYNTAX评分是影响ACS患者短期预后的独立危险因素。结论 ACS患者心电图上出现fQRS能够反映出冠脉病变的严重程度,且可以作为短期预后的独立预测指标。Objective To investigate the correlation between fragmented QRS complex(fQRS) and coronary artery lesions and short-term adverse cardiovascular events in patients with acute coronary syndrome(ACS).Methods The clinical data of 361 ACS patients with laboratory examination,electrocardiogram,and coronary angiography were retrospectively analyzed,and the severity of coronary lesions was quantitatively evaluated by the Gensini score and SYNTAX score.They were divided into fQRS(+) group and fQRS(-) group according to the presence or absence of fQRS on the electrocardiogram.They were followed up for 6 months after discharge,and the major adverse cardiovascular events(MACE) were recorded.Compare the difference between the two groups in the occurrence of coronary artery disease and MACE,and look for the risk factors that affect the short-term prognosis of patients with ACS.Results Among a total of 142 patients,the detection rate of fQRS on ECG was 39.3%(142/361).The fQRS detection rate in STEMI and NSTEMI patients was significantly higher than that of UA patients(P<0.05).Compared with the fQRS(-) group,the three-vessel disease was more common in the fQRS(+) group,with higher Gensini score and SYNTAX score,and a higher incidence of MACE within 6 months(48.5% vs 13.2%,P<0.05).Unplanned revascularization,heart failure,and recurrence of angina were the main causes.Multivariate logistic regression analysis found fQRS,Gensini score,SYNTAX score are independent risk factors affecting the short-term prognosis of patients with ACS.Conclusion The presence of fQRS on the ECG in ACS patients can reflect the severity of coronary artery disease and can be used as an independent predictor of short-term prognosis.

关 键 词：冠状动脉粥样硬化 心电描记术 心血管生理学现象 预后 

分 类 号：R541.4[医药卫生—心血管疾病]