| Background:The prognosis of acute myocardial infarction is directly related tothe myocardial infarct area.Therefore,assessment of myocardial infarct area is veryimportant to the clinical work. The standard12-lead electrocardiogram can be used toestimate myocardial infarct area by applying the Selvester54-criteria/32-point QRSscoring system.The Wanger simplified37-criteria/29-point QRS scoring system basedon the Selvester QRS scoring system is more convenient, more suitable for clinicalapplication. Few studies have demonstrated an association between infarct area asassessed by QRS scoring with clinical outcomes. No study has evaluated the prognosticvalue of the QRS score in patients with acute ST-segment elevation myocardialinfarction （STEMI） undergoing primary percutaneous coronary intervention (PCI) inour country.Objective: The purpose of this study was to evaluate the predictive value of QRSscore on90-day sudden cardiac death,heart failure in patients with STEMI undergoingprimary PCI.Methods: We conducted a prospective cohort study in110consecutive patientswith acute STEMI who underwent successful (TIMI-3flow) primary PCI at the FirstAffiliated Hospital of Dalian Medical University between2011.1-2012.1. The Wanger37-criteria/29-point QRS scoring system on the seventh day electrocardiogram wascalculated and QRS scores were divided into two groups (QRS score≤3group and>3group).Clinical data, CAG characteristics, the peak value of cardiac enzyme and90-daysudden cardiac death/heart failure were analyzed. Data was analyzed by SPSS17.0statistical software.Results：There were28patients in QRS score≤3group and82patients in QRS> 3group. The mean age of the two groups were (54.14±8.43) years and (58.41±11.33)years respectively, they were not statistically significant (P>0.05). Compare to QRSscore≤3group, in QRS score>3group, the level of heart rate was more faster（78.95±18.09beat/min vs70±13.61beat/min, P<0.05）; The amount of noninferiorinfarction was much more（57.30%vs35.70%, P<0.05）;The range of ST-segmentelevation was greater（14.96±8.78mm vs7.29±2.49mm, P＜0.05）; Patients ofST-segment decrease more than50%after PCI were fewer （56.12%vs78.60%, P＜0.05）; Time to reperfusion was longer（6.49±2.33h vs5.32±2.02h, P<0.05）; The ratioof impaired culprit artery restore blood flow before PCI was significantly lower（4.90%vs17.91%, P<0.050）; The peak value of cardiac enzyme was notable higher:peak CK（ratio of ULN）（11.48±8.01vs6.93±4.19P<0.05),peak CKMB（ratio of ULN）（75.09±60.21vs50.22±46.02P<0.05),peak TnI（ratio of ULN）（1169.54±1268.83vs577.59±509.39P<0.05). Adjusted associations between QRS score and90-dayoutcomes (sudden cardiac death/heart failure) were examined. Adverse outcomes occurredmore often in patients with higher QRS scores (90-day sudden cardiac death/heart failure:0,QRS score≤3;17.1%,QRS score>3). After adjusting for baseline characteristics, highQRS score remained a strong independent predictor of adverse outcome(OR1.39,95％CI1.06-1.83,P=0.017).Conclusions: QRS score is an independent and prognostically relevant metric inpatients with STEMI undergoing primary PCI. |
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