Background:The early mitral inflow velocity to mitral early diastolic velocity ratio (E/e′) and electrocardiogram (ECG) determination of QRS score are useful for risk stratification in patients with ST-elevation myocardial infarction (STEMI).

Methods and Results:In this study, 420 consecutive patients (357 male; mean [±SD] age 63.6±12.2 years) with first-time STEMI who successfully underwent primary percutaneous coronary intervention within 12 h of symptom onset were followed-up for 5 years (median follow-up 67 months). Echocardiography, ECG, and blood samples were obtained 2 weeks after onset. Infarct size was estimated by the QRS score after 2 weeks (QRS-2wks) and creatine phosphokinase-MB concentrations (peak and area under the curve). The primary endpoint was death from cardiac causes or rehospitalization for heart failure (HF). During follow-up, 21 patients died of cardiac causes and 62 had HF. Multivariate Cox proportional hazard analysis showed that mean E/e′ (hazard ratio [HR] 1.152; 95% confidence interval [CI] 1.088–1.215; P<0.0001), QRS-2wks (HR 1.153; 95% CI 1.057–1.254; P<0.0001), and hypertension (HR 1.702; 95% CI 1.040–2.888; P=0.03) were independent predictors of the primary endpoint. Kaplan-Meier curve analysis showed that patients with QRS-2wks >4 and mean E/e′ >14 were at an extremely high risk of cardiac death or HF (log rank, χ²=116.3, P<0.0001).

Conclusions:In patients with STEMI, a combination of QRS-2wks and mean E/e′ was a simple but useful predictor of cardiac death and HF.

背景：早期二尖瓣流入速度与二尖瓣早期舒张速度比（E/e'）和心电图（ECG）测定 QRS 评分有助于 ST 段抬高型心肌梗死（STEMI）患者的风险分层。

方法和结果：在这项研究中，连续 420 名首次 STEMI 患者（357 名男性；平均 [±SD] 年龄 63.6±12.2 岁）在症状出现后 12 小时内成功接受了直接经皮冠状动脉介入治疗，并对其进行了 5 年的随访（中位随访时间） -最多 67 个月）。发病 2 周后获得超声心动图、心电图和血液样本。通过 2 周后的 QRS 评分（QRS-2wks）和肌酸磷酸激酶-MB 浓度（峰值和曲线下面积）估计梗塞面积。主要终点是心脏原因死亡或心力衰竭（HF）再住院。在随访期间，21 名患者死于心脏原因，62 名患者患有 HF。多变量 Cox 比例风险分析显示平均 E/e'（风险比 [HR] 1.152；95% 置信区间 [CI] 1.088–1.215；P<0.0001），QRS-2wks（HR 1.153；95% CI 1.057–1.254； P<0.0001), 和高血压（HR 1.702；95% CI 1.040–2.888；P=0.03）是主要终点的独立预测因子。Kaplan-Meier 曲线分析显示 QRS-2wks >4 且平均 E/e' >14 的患者发生心源性死亡或 HF 的风险极高（log rank，χ² = 116.3，P<0.0001)。

结论：在 STEMI 患者中，QRS-2wks 和平均 E/e' 的组合是心脏死亡和 HF 的一个简单但有用的预测因子。