| Objective:This dissertation aim s to investigate the predictive value of QRS distortion combined with early pathological Q wave in STEMI patients undergoing PCI.Methods:On the basis of inclusion and exclusion criteria,the research retrospectively analyzed 392 patients who were first diagnosed with STEMI and received emergency PCI treatment in the cardiac catheterization room via the emergency green channel within 12 hours of onset at the Subei People's Hospital from June 2018 to December 2019.According to the presence of pathological Q waves on the ECG at the time of admission,patients were divided into pathological Q wave(-)group and pathological Q wave(+)group;According to the presence of QRS distortion on the ECG at the time of admission,patients were divided into QRS distortion(-)group and QRS distortion(+)group;The pathological Q wave(-)or QRS distortion(-)is recorded as 0 points,and the pathological Q wave(+)or QRS distortion(+)is recorded as 1 point,and the two groups are combined to obtain group point 0,group point 1 and group point 2.On the other hand,baseline data,biomarkers,coronary angiography,electrocardiogram and other examination results of all patients were strictly collected during this period ofestigmae.Additionally,the occurrence of MACEs during the hospital stay,including death,acute heart failure,and cardiogenic shock,was carefully observed as well.Then,patients who survived and discharged from the hospital were followed up and medication discharge and out-of-hospital MACEs were recorded,including death,acute heart failure,and recurrent myocardial infarction.the data of each subgroup were compared and analyzed statistically.Results:392 patients were successfully treated with PCI,among which there were 277 males and 115 females,mean age(63.62} 10.07)years old.The incidence of pathological Q wave was 45.91%,the incidence of QRS distortion was 30.10%,the incidence of both was 16.07%.10 patients died in hospital,and the rest 382 patients,who survived and discharged were followed up for 6-18 months,The average follow-up time of 11.06:3.44 months.1.Comparison of clinical data results shows that:(1)Compared with patients in the pathological Q wave(-)group,patients in the pathological Q wave(+)group were older,were more often with longer time from symptom onset to door,had a higher proportion of infarct-related artery(IRA)for left anterior descending,complete occlusion of IRA and ST-segment resolution(STR)<70%,and had higher peak value o”f cTnI,the difference are statistically significant(p<0.05).(2)Compared with patients in the QRS distortion(-)group,patients in the QRS distortion(+)group had a lower proportion of preinfarction angina,collateral circulation,had a higher proportion of IRA for left anterior descending,complete occlusion of IRA,proximal occlusion of IRA and ST-segment resolution(STR)<70%,and had higher peak value of cTnI,the difference are statistically significant(p<0.05).(3)Compared with patients in group point 0 and group point 1,patients in group point 2 had a higher proportion of IRA for left anterior descending,complete occlusion of IRA,proximal occlusion of IRA and ST-segment resolution(STR)<70%,and had higher peak value of cTnI,the difference are statistically significant(p<0.05).2.In-hospital MACEs results shows that:(1)The incidence of in-hospital MACEs in the pathological Q wave(+)group during hospitalization was significantly higher than that in the pathological Q wave(-)group(17.22%vs 7.07%,p<0.05).Multivariate logistic regression analysis showed that pathological Q waves was an independent predictive factor of in-hospitals MACEs in STEMI patients undergoing emergency PCI(OR=2,188,95%CI 1,067-4.489,p=0.033).(2)The incidence of in-hospital MACEs in the QRS distortion(+)group during hospitalization was significantly higher than that in the QRS distortion(-)group(20.3%3 vs 8.02%,p<0.05).Multivariate logistic regression analysis showed QRS distortion was an independent predictive factor of in-hospitals MACEs in STEMI patients undergoing emergency PCI(OR=2.127,95%CI 1.037-4.361,P=0.039)(3)the incidence rates of in-hospital MACEs gradually increased with the increase of integration(25.39%vs 13.37%4.45%,p<0.05).Group point 0 was used as the reference group,the results of multivariate logistic regression analysis showed that group point 2 vs group point 0(OR=4.557,95%CI 1.580-13.143,p=0.005),group point 1 vs group potin 0(OR=2.908,95%CI 1.138-7.432,p=0.026).QRS distortion combined with pathological Q wave was an independent predictor of in-hospital MACEs in STEMI patients undergoing emergency PCI.3.Out-of-hospital MACES results shows that:(1)Kaplan-Meier analysis showed that the cumulative incidence rates of out-of-hospital MACEs in patients with pathological Q wave(+)group was significantly higher than that in patients with pathological Q wave(-)group(log-rank test,p=0.010).Multivariate Cox regression analysis showed that pathological Q waves was an independent predictive factor of out-of-hospital MACEs in STEMI patients undergoing emergency PCI(OR=2.046,95%CI 1.016-4.118,p=0.045).(2)Kaplan-Meier analysis showed that the comulative incidence rates of out-of-hospital MACEs in patients with QRS terminal deformation(+)group was higher than that in QRS distortion(-)group(log-rank test,p=0.001).Multivariate Cox regression analysis showed that was an independent predictive factor of out-of-hospital MACEs in STEMI patients undergoing emergency PCI(OR=2.287,95%CI 1.136-4.603,p=0.020).(3)Kaplan-Meier analysis showed that the cumulative incidence rates of out-of-hospital MACEs gradually increased with the increase of integration(log-rank test,p=0.001).Group point 0 was used as the reference group,the results of multivariate Cox regression analysis showed that group point 2 vs group point 0(OR = 4.643,95%CI 1.646-13.094,p=0.004),group point 1 vs group point 0(OR=2.783,95%CI 1.083-7.153,P=0.034).QRS distortion combined with pathological Q wave was an independent predictor of in-hospital MACEs in STEMI patients undergoing emergency PCI.Conclusions:1.patients with QRS distortion or pathological Q wave had larger myocardial necrosis area and poorer microcirculation reperfusion ability.Patients with both QRS distortion and pathological Q wave had larger myocardial necrosis area and poorer microcirculation reperfusion ability than those without or with only one indicator.2.patients with QRS distortion or pathological Q wave had a higher risk of in-hospital and out-of-hospital MACEs.Patients with both QRS distortion and pathological Q wave had a significantly higher risk of MACEs in and out of the hospital than patients without or with only one indicator.3.QRS distortion,pathological Q waves and a combination of both could be used as independent predictors MACEs in STEMI patients undergoing emergency PCI. |
PDF Full Text Request