| Objective: This study aimed to explore the risk factors of fragmented QRS complex(fQRS)in patients with ST-segment elevation myocardial infarction(STEMI)and the predictive value of fQRS for hospital complications and adverse events in STEMI.Methods: This study was a retrospective,single-center observational study.A total of 742 STEMI patients admitted to CCU of heart center of the first hospital of Lanzhou University from January 2019 to December 2019 were collected.According to the inclusion and exclusion criteria,588 patients were included.The diagnostic criteria of fQRS was narrow fQRS.Patients were divided into fQRS positive group and fQRS negative group according to whether fQRS was present in the electrocardiogram(ECG)at the first admission.The two groups were compared in terms of past medical history,general conditions,ECG characteristics,laboratory examination characteristics,coronary artery lesions and medication.Multivariate logistic regression was performed to analyze the risk factors of fQRS.In the prediction of fQRS,the primary endpoints were defined by all-cause mortality(including in-hospital and 1-year follow-up all-cause mortality)and ventricular tachycardia(VT),and the secondary endpoints were defined by atrial fibrillation,bleeding,and stroke.The differences of all-cause mortality,VT and atrial fibrillation between the fQRS positive group and the negative group were compared.Univariate analysis was performed for all endpoints,and the sensitivity,specificity,predictive value and likelihood ratio of the end points with statistical differences were calculated.In terms of primary endpoint events,univariate and multivariate Logistic analyses were performed for risk factors of VT events.All patients were followed up for 1 year,with all-cause mortality as an outcome event and univariate Kaplan-Meier analysis for all-cause mortality.Subgroup analysis were performed in an effort to identify risk and protective factors in VT events after STEMI patients with positive fQRS.Baselline data were first compared,and significant variables were included in univariate and multivariate Logistic regression analysis.In order to find out the protective factors and risk factors of in-hospital VT event in patients with STEMI complicated with FQRS after admission.Results: According to the inclusion and exclusion criteria,a total of 588 patients with STEMI were included,including fQRS positive group(n=200)and fQRS negative group(n=388).In terms of baseline data,LVEF value,Killip grade,old myocardial infarction,NT-pro BNP peak,pathological Q wave and LAD lesions in fQRS positive group were higher than that in fQRS negative group(p <0.05),the QTc interval in fQRS positive group was longer than that in fQRS negative group,while the LVEF value in fQRS positive group was lower than that in fQRS negative group.Through the multivariate Logistic regression analysis of fQRS,it was found that Killip grade≥2(OR=1.58,95%CI=1.01-2.46,P=0.043),pathological Q wave(OR=2.52,95 %CI=1.56-3.96,P<0.001),QTc interval(OR=1.005,95%CI=1.001-1.009,P=0.024),old myocardial infarction(OR=3.79,95%CI=1.47-9.76,P=0.006)and LAD lesions(OR=1.52,95%CI= 1.06-2.18,P=0.022)were independent risk factors for the formation of fQRS.In terms of prediction value of fQRS for in-hospital adverse events and complications,the risk of 1 year follow-up all-cause mortality(OR=3.13,95%CI=1.56-6.31,P=0.001)and VT events(OR=2.38,95% CI=1.54-3.66,P<0.001)in fQRS positive group was significantly higher than that in fQRS negative group,especially in the risk of in-hospital mortality(OR=7.47,95%CI =2.05-27.09,P<0.001),VT with unstable hemodynamics(OR=8.92,95%CI=2.51-31.69,P<0.001)and ventricular fibrillation(VF)(OR=6.05,95%CI=1.62-22.59,P=0.004).Meanwhile,fQRS has a strongly negative predictive value in predicting in hospital all-cause mortality,one-year all-cause mortality,VT,VT with unstable hemodynamics and VF events.Multivariate Logistic analysis of in-hospital VT events showed that fQRS(OR=2.44,95%CI=1.44-4.13,P=0.001)and emergency PCI(OR=2.78,95%CI=1.06-7.28,P=0.038)were independent risk factors of VT events,higher LVEF(OR=0.94,95%CI=0.91-0.98,P=0.001)was independent predictive factor of VT events.ROC analysis showed that the optimal LVEF cut-point for predicting in-hospital VT events in patients with STEMI was 49.5%.For all-cause mortality,the patients were followed up for one-year.The survival changes were described by Kaplan-Meier curve,and Log-rank test was used to compare the two groups.The results showed that the risk of one-year follow-up mortality in fQRS positive group was higher than that in fQRS negative group(Log Rank positive group vs.fQRS negative group,p=0.001),and the major risk of death occurred within the first month of follow-up.In the patients with STEMI complicated with fQRS,Multivariate Logistic regression analysis showed that prolonged QRS duration(OR=1.05,95%CI=1.01-1.08,P=0.014)was an independent risk factor for VT events in STEMI patients with fQRS.History of hypertension(OR=0.44,95%CI=0.21-0.92,P=0.028),β-blocker(OR= 0.42,95%CI=0.20-0.88,P=0.021)and high level of LVEF(OR=0.93,95%CI =0.88-0.97,P=0.002)were independent protective factors for VT in fQRS with STEMI.The optimal QRS duration and LVEF cut-point for predicting VT events in STEMI patients with fQRS was 93.5ms and 48.5% by ROC analysis,respectively.Conclusion: Fragmented QRS of the first ECG in patients with STEMI was independently associated with old myocardial infarction,pathological Q wave,prolonged QTc interval,LAD and Killip≥2 in STEMI patients.And the appearance of fQRS from the first ECG on admission indicates that the risk of mortality and VT in patients with STEMI is significantly increased,especially for in-hospital mortality,VT with unstable hemodynamics and VF.For the STEMI patients with fQRS of the first ECG,the increase ofQRS duration is independent risk factor for the development of VT.β-blockers and high level of LVEF are the independent protective factors of VT.Therefore,for fQRS with STEMI patients,β-blockers should be used early to prevent the occurrence of VT events. |
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