Correlation Between Fragmented QRS Complex Wave And Coronary Artery Disease Severity And Criminal Vessel In Acute Myocardial Infarction

Background and purpose:Acute myocardial infarction is a persistent ischemic hypoxic necrosis of the myocardium caused by a sharp decrease or interruption of coronary blood flow.It is a cardiovascular disease with a very high mortality rate and a poor prognosis.Its main treatment is to open the main criminal blood vessels.Fragmented QRS(fQRS)is a characteristic feature of electrocardiogram,which is closely related to myocardial ischemia and myocardial scarring.The purpose of this study was to investigate the relationship between the presence of fQRS and the degree of coronary lesions in the admission electrocardiogram of patients with acute myocardial infarction,and to determine the criminal vessels based on the position of the lead where fQRS appears.Materials and Methods:A total of 365 patients with acute myocardial infarction were included,aged 28-96 years,with an average age of(62.00±17.50)years.On admission,a standard twelve-lead electrocardiogram was performed and divided into two groups based on the presence or absence of fQRS in the admission electrocardiogram:174 patients in the fQRS group and 191 patients in the non-fQRS group.The electrocardiogram lead positions in the fQRS group were recorded.All patients underwent coronary angiography,and the criminal blood vessels were identified based on the coronary angiography results of these patients and the Gensini score was calculated.The general data,Gensini score,and number of severely narrowed coronary arteries were compared between two groups.The relationship between the fQRS and the severity of coronary lesions in the admission electrocardiogram of patients with acute myocardial infarction was analyzed.At the same time,the distribution of different criminal vessels in fQRS at different locations was also studied to determine whether the criminal blood vessels could be located according to the position of fQRS in the electrocardiogram.Results:(1)174 patients in the fQRS group and 191 patients in the non-fQRS group.There was no significant difference in the gender,age,time from onset to admission,history of smoking,history of hypertension,history of diabetes,high-density lipoprotein,low-density lipoprotein,triglycerides,total cholesterol and left ventricular ejection fraction between the two groups(p>0.05).The Gensini score of the fQRS group was 47(32,68),and the Gensini score of the non-fQRS group was 38(24,57).There was a statistical difference in Gensini score between the two groups(p<0.05).(2)The number of stenoses>70%in the three main coronary arteries(anterior descending artery,left circumflex atery and right coronary atery)was recorded.In the fQRS group,there were 109 cases with single coronary stenosis>70%,41 cases with double coronary stenosis>70%and 24 cases with three coronary stenosis>70%.There were 139 cases with single coronary stenosis>70%,39 cases with double coronary stenosis>70%and 12 cases with three coronary stenosis>70%in the non-fQRS group.There was no significant difference in the proportion of double coronary stenosis>70%between the two groups(p=0.49).The proportion of single coronary stenosis>70%in the fQRS group was less than that in the non-fQRS group(p=0.03).The proportion of three coronary stenosis>70%was larger than that in the non-fQRS group(p=0.02).(3)The Gensini score was divided into low score group(<32),median score group(32-54)and high score group(?54)according to the third quartile.Ordered multi-class logistic regression analysis was used to analyse the effect of with or without fQRS,single or multiple coronary stenosis>70%,gender,age,time from onset to admission,history of smoking,history of hypertension,history of diabetes,high-density lipoprotein,low-density lipoprotein,triglycerides,total cholesterol on Gensini scores with different grades.The results showed that fQRS(OR=1.58,95%CI 1.07-2.32,p=0.02)and multiple coronary stenosis>70%(OR=2.33,95%CI 1.53-3.53,p<0.001)were independent predictors predicting high Gensini scores.(4)In the fQRS group,there were 131 cases of fQRS in inferior leads,24 cases of fQRS in anterior leads,6 cases of fQRS in lateral leads,8 cases of fQRS in inferior leads+anterior leads,3 cases of fQRS in inferior leads+lateral leads and 2 cases of fQRS in inferior leads+anterior leads+lateral leads.The frequency of fQRS in inferior leads was significantly higher than that in anterior leads(p<0.001)and significantly higher than that in lateral leads(p<0.001).(5)According to the criminal vessels that confirmed by coronary angiography,in the fQRS group of inferior leads(n=131),there were 80 cases of left anterior descending branch,21 cases of left circumflex branch,and 30 cases of right coronary artery.In the fQRS group of anterior leads(n=24),there were 14 cases of left anterior descending branch,4 cases of left circumflex branch,and 6 cases of right coronary artery.In the fQRS group of lateral leads(n=6),there were 2 cases of left anterior descending branch,2 cases of left circumflex branch,and 2 cases of right coronary artery.The results showed that there was no statistical difference in the distribution of criminal vessels between the three groups(p=0.61).Conclusions:(1)The Gensini score of patients with acute myocardial infarction with fQRS on admission electrocardiogram was significantly higher than those without fQRS,and fQRS was an independent predictor of high Gensini score in patients with acute myocardial infarction.FQRS could reflect the severity of coronary artery disease in patients with acute myocardial infarction to a certain extent.(2)FQRS mostly appeared in the inferior leads of the electrocardiogram.The location of the fQRS distribution leads was not consistent with the criminal vessels confirmed by coronary angiography.Therefore,the criminal vessels of patients with acute myocardial infarction could not be determined based on the location of the electrocardiogram leads where fQRS appeared.