| Objectives:The purpose of this study was to investigate the related clinical factors of fragmented QRS complexes in patients with acute ST-segment elevation myocardial infarction and to explore the predictive value of fragmented QRS complexes in patients with acute ST-segment elevation myocardial infarction for coronary artery disease and adverse cardiovascular events during hospitalization after PCI.Methods:1.A total of 436 patients who underwent percutaneous coronary intervention(PCI)for acute ST-segment elevation myocardial infarction at the Cardiovascular Clinic of the First Hospital of Jilin University from January 2018 to July 2018 were enrolled.All enrolled patients underwent coronary artery stenting to open target vessels within the time window and were treated with standard internalized procedures after surgery.2.Collect baseline data(gender,age,location of myocardial infarction,Killip classification),past medical history(history of hypertension,history of diabetes,history of hyperlipidemia,smoking history),basic vital signs on admission(systolic pressure,diastolic blood pressure,heart rate),the first ECG on admission(whether appear fQRS,fQRS waveguide coupling),laboratory indicators on admission(BNP,Mb,cTNI,CK-MB,D-D),coronary angiography results(advantage,vascular lesion blood vessel number,the degree of vascular stenosis,criminal vascular,intervention vascular blood flow TIMI grading,GenSini score),coronary stent parameters(number,diameter,length),postoperative cardiac ultrasound results(ej ection fraction,left ventricular end-diastolic diameter),and adverse cardiovascular events during postoperative hospitalization(cardiac death,cardiac shock,heart failure after myocardial infarction and terriers,malignant arrhythmia including ventricular fibrillation,ventricular tachycardia,polymorphous early and highly atrioventricular block).3.The differences in baseline data,coronary artery lesions,and adverse cardiovascular events during hospitalization between fQRS negative group and fQRS positive group were analyzed.4.The differences in baseline data,coronary artery lesions,and Adverse cardiovascular events during hospitalization were analyzed between patients with fQRS in 2 leads and patients with fQRS in more than 2 leads.5.Explore independent clinical risk factors for fQRS in patients with acute ST-segment elevation myocardial infarction.6.IBM SPSS Statistics 25.0 software was used for statistical analysis.Conform to the normal distribution of measurement data,using the mean ± standard deviation(x±S)said,comparison between groups use independent sample t-test;Measurement data that did not conform to normal distribution were represented by median(P25,P75),and comparison between groups was performed by Mann-Whitney U test or Krnskal-Wallis rank-sum test.Enumerative data were expressed as frequency(percentage),and Pearson’s chi-square test or Fisher’s exact probability method were used for comparison between groups.Univariate and multivariate analyses were performed by binary Logistic regression to investigate independent clinical risk factors for fQRS.All statistical tests were bilateral,P<0.05 indicates that the difference is statistically significant.Result:1.The probability of fQRS of STEMI patients was 36.24%.There was no significant difference in baseline data between the fQRS negative group and the fQRS positive group:gender,history of hypertension,history of hyperlipidemia,smoking history,and physical examination on admission.2.Compared with the fQRS negative group,the fQRS positive group has larger left ventricular end-diastolic diameter(LVEDD),lower ejection fraction(EF)after PCI,and higher laboratory indicators on admission.The fQRS positive group had a heavier vascular stenosis degree of LAD and LCX,a bigger probability that LAD was criminal blood vessels,a more number of stent placement,the length of stent is longer,a higher Gensini score,a larger probability of hospitalization adverse cardiovascular events(cardiac death after myocardial infarction,heart failure,cardiac shock and malignant arrhythmia)(P<0.05).3.Compared with the fQRS in 2 leads,the fQRS in more than 2 leads had a higher probability of the criminal blood vessels being LAD,a higher probability of multi-vessel disease,a higher Gensini score,and a larger probability of hospitalization adverse cardiovascular events(cardiogenic shock,heart failure after myocardial infarction,malignant arrhythmia)(P<0.05).4.Through univariate analysis and multivariate analysis,age(OR=1.025;95%CI:1.006-1.045,P=0.011),Killip grade(OR=1.776;95%CI:1.019-3.094,P=0.043),inferior wall myocardial infarction(OR=2.225;95%CI:1.059-4.675,P=0.035)were independent risk factors for fQRS in STEMI patients.The age(OR=1.025;95%CI:1.004-1.044,P=0.020),fQRS(OR=3.617;95%CI:2.279-5.739,P<0.001)were independent risk factors for adverse cardiovascular events during hospitalization after PCI in patients with acute STEMI.Conclusions:1.Age,Killip grade,and inferior wall myocardial infarction were independent influencing factors for fQRS in patients with acute ST-segment elevation myocardial infarction.2.In the fQRS positive group,the criminal blood vessel was LAD,the proportion of three-vessel coronary disease and the Gensini score was higher,suggesting that the severity of coronary disease in patients with acute ST-segment elevation myocardial infarction with fQRS was more serious than that without fQRS.3.With the increase of the number of fQRS waveguide connections,the proportion of three coronary artery lesions and the Gensini score also increased,suggesting that the more the number of fQRS leads in patients with acute STEMI,the more severe the coronary artery lesions of patients.4.The fQRS is a predictor of in-hospital adverse cardiovascular events in patients with acute STEMI after PCI,and the higher the number of fQRS leads,the higher the probability of in-hospital adverse cardiovascular events in patients.Should cause clinical high attention. |
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