Correlation Between Fragmented QRS Complex And Coronary Artery Lesions And Short-term Prognosis In Patients With Acute Coronary Syndrome

Objective: Acute coronary syndrome(ACS)has become one of the important "killers" that threaten people's life and health due to its severe symptoms,poor prognosis,and high mortality.Therefore,it is necessary to identify high-risk patients early in the clinic.This study investigated whether there was a correlation between the fragmented QRS complex(f QRS)and the characteristics and severity of coronary lesions by observing the results of ECG and coronary angiography in patients with ACS;all patients were followed up for six months to observe the occurrence of major adverse cardiovascular events and to investigate whether the existence of f QRS can have a certain predictive value for the short-term prognosis of patients with ACS,and to help identify high-risk populations early and clinical intervention.Methods: A total of 361 ACS patients diagnosed by coronary angiography in the Department of Cardiology of Anhui Provincial Hospital from April 2018 to April 2019 were consecutively selected.Within 48 hours of admission,a routine 12-lead ECG was performed.According to the presence or absence of f QRS,it was divided into f QRS(+)and f QRS(-)groups.The baseline data,laboratory tests,echocardiograms,and coronary angiography results of each group were recorded in detail,and the Gensini score and SYNTAX score were calculated to quantitatively assess the severity of the lesions,and compare whether there is a difference in these clinical data between the two groups.All patients were followed up for 6 months after discharge.The incidence of major adverse cardiovascular events(MACE)during the follow-up period was recorded.The patients were divided into two subgroups,MACE(+)and MACE(-).Compare the clinical data of the two subgroups and find the influencing factors of MACE.Results:The 361 ACS patients included in the study included 97 patients with unstable angina pectoris(UA),104 patients with non-ST-elevation myocardial infarction(NSTEAM)and 160 patients with ST-elevation myocardial infarction(STEAM).A total of 142 patients showed f QRS on the electrocardiogram,and the total detection rate was39.3%(142/361).There was no statistical difference in f QRS(+)and f QRS(-)groups in terms of age,gender,BMI,hypertension,and diabetes(P>0.05).Compared with f QRS(-)group,patients in f QRS(+)group had faster resting heart rate,lower systolic blood pressure level,white blood cell count,high-sensitivity C-reactive protein,troponin,creatine kinase isoenzyme,NT-Pro BNP High level,large left ventricular end-diastolic volume,low left ventricular ejection fraction(P<0.05),no significant differences in red blood cell and platelet counts,blood lipids,liver and kidney function and other indicators;the patients in the f QRS(+)group were mainly STEMI and NSTEMI.The angiography showed that the number of lesion vessels was more than 3,and the Gensini score,SYNTAX score,and MACE incidence during follow-up were higher than those in the f QRS(-)group(P<0.05).MACE mainly includes unplanned revascularization,heart failure,and recurrent angina.Compared with MACE(-)subgroups,patients in MACE(+)group had a fast resting heart rate,low systolic blood pressure,red blood cell count,and hemoglobin levels;white blood cell count,hypersensitive C-reactive protein,and NT-The level of Pro BNP is high,and the diameter of the left ventricle is large during the end diastole and the left ventricular ejection fraction is low(P <0.05).There is no statistical difference in the other indicators.There was no significant difference in clinical type and number of diseased vessels between the two groups(P>0.05),but the Geneini score and SYNTAX score of the MACE(+)group were higher(P<0.05).Multivariate Logistic regression analysis indicated f QRS(OR = 5.642,95% CI: 2.855 ~ 11.037;P <0.001),Gensini score(OR =1.020,95% CI: 1.005 ~ 1.036;P = 0.008),SYNTAX score(OR = 1.071,95% CI: 1.019~ 1.126;P = 0.006)were independently associated with the occurrence of MACE within six months of ACS patients.Conclusion: The appearance of fQRS on the surface electrocardiogram of patients with acute coronary syndrome can reflect the severity of coronary artery disease and can be used as an independent predictor of short-term prognosis.