Background

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).

Methods

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.

Results

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).

Conclusion

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.

中文翻译：

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QRS复合物碎片对急性心肌梗死患者的预后价值。

背景

已经研究了几种因素和风险分层工具来确定急性冠状动脉综合征的预后。碎片QRS（fQRS）是心肌疤痕的标志物，最近已证明其预后作用。本研究旨在调查心电图中fQRS的存在与ST段抬高和非ST段抬高心肌梗死（STEMI和NSTEMI）之间的关系。

方法

回顾性研究共纳入661例心肌梗死（MI）患者。根据入院心电图中fQRS的存在，将患者分为两组。所有患者均接受了6个月的随访，并记录了所有主要的不良心血管事件（MACE）。

结果

患者的平均年龄为61.3±1.2岁，男性为71.7％。在急性期，阳性fQRS组的局部壁运动异常和主动脉瓣关闭不全的检出率高于阴性fQRS组（p  = 0.003）。在所有患者中以及在STEMI和NSTEMI亚组中，阳性fQRS组的总MACE发生率均明显高于阴性fQRS组（p  <0.001）。基于多变量分析，在6个月的随访中，fQRS和高血压的存在是总MACE的最强预测因子（几率[OR] = 5.929； 95％置信区间[CI] = 3.620-9.709；p  <0.001和OR = 2.220； 95％CI = 1.390-3.547；p  <0.001）。

结论

不论MI的类型如何，都可以在急性心梗患者的风险分层工具中实现入院心电图上存在fQRS。