| background: As we all know, coronary heart disease is a severe disease thatadversely affects people’s health. Acute myocardial infarction (AMI) is the mostsevere type of coronary heart disease, which mortality is about30%. Almost half ofpatients with myocardial infarction are dead before being hospitalized. Five to tenpercent of survivors from acute stage will die in one year after the initial myocardialinfarction. Pathological Q waves were considered to be the marker of a trans-mural MI,predictor of a poor prognosis, and increase the the short term and long term mortality.After performing of thrombolytic therapy and primary percutaneous coronaryintervention, the mortality has been significantly decreased. Some of trans-mural MIin-patients with occlusive coronary arteries had re-canalization which reduced themyocardial necrosis after re-perfusion therapy. At least two thirds of patients withprior myocardial infarction that had this treatment showed electrocardiograms with nopathological Q waves. There are some patients, over time, because of the recoveringmyocardium after the initial shock of the MI will gradually improve and thepathological Q wave will decrease or totally disappear.objective: Study on the correlation between body surface electrocardiogram offragmented QRS (fQRS) complex and acute ST segment elevation myocardialinfarction, vascular lesions of coronary lesions, degree, and at the same timeobservation of fQRS wave in the detection rate of PCI in preoperative, postoperative and acute ST segment elevation myocardial infarction related factors (sex, age, diabetes,hypertension, left ventricular ejection fraction, coronary collateral circulation) and therelationship between fQRS detection rate.Method:We retrospectively examined85patients with prior MI hospitalized in“The First Afflicted Hospital of Dalian Medical University”. In this study, the85patients are divided into two groups which are fQRS group (n=53) and non-fQRS group(n=32) according their ECG results. With the admission results of coronaryangiography and echocardiography in comparison to the fQRS wave in different scopeand degree of coronary artery lesion, the detection rate of fQRS wave and aVR leads inthe detection rate of multi-vessel lesions, PCI preoperative, postoperative fQRS wavehad no change. Data are expressed as mean±SD or n (%). Comparisons ofcontinuous variables were performed using the unpaired t test. Comparisons ofcategorical variables were performed using the chi-square test.Results:1. fQRS wave in the anterior descending artery, the left circumflex coronaryartery, right of different vascular lesion and non lesion groups respectively62.3%&29.2%、81.8%&34.6%、65.5%&30.0%. The difference was statistically significant2. fQRS in acute ST segment elevation myocardial infarction and coronary arterynormal single branch lesion group of very low detection rate were6.7%and0%, in thedetection of double branch lesions and three lesions in the higher rates were75%and100%. Statistically significant differences between different lesions coronary fQRSexamination rate exists.3. The detection rate of fQRS in lead aVR in single vessel coronary arterydisease and multi-branch lesions were3.2%and68.5%, the difference has statisticalsignificance.4. The different degree of stenosis in patients with fQRS wave incidence in thedegree of coronary artery stenosis group <70%, stenosis was70%-99%with coronarytotal occlusion detection rates were0%,48.5%and59.2%, no significant difference(P>0.05), but the positive trend. 5. The degree of coronary artery stenosis in different patients, fQRS wave in leadnumber in the detection rate of PCI before operation, after operation in the degree ofcoronary artery stenosis was no significant difference in50%-69%group (P>0.05); andthe significance in the degree of stenosis is a statistically significant difference betweenthe70%-90%,91%-100%two groups in the fQRS wave detection rate in the number oflead in PCI preoperatively and postoperatively.（P<0.05)6. There was no statistically significant difference between sex, age, the detectionrate of diabetes, hypertension and fQRS wave (P<0.05). No statistically significantdifferences between the left ventricular ejection fraction and collateral circulation andfQRS wave detection rate (P<0.05), but a normal ejection fraction and reduced groupand collateral circulation with no collateral circulation between group can see thepositive trend.Conclusion:1. In patients with acute ST segment elevation myocardial infarction, fQRS hassome value in the diagnosis of ischemia, may indicate some degree thereof.2. Early percutaneous coronary intervention (PCI), opened coronary artery,improve myocardial ischemia and reduce myocardial necrosis, and reduce theprevalence rate of ECG with fQRS. The positive rate of fQRS in preoperative,postoperative early PCI can improve myocardial ischemia and reduce the myocardialnecrosis.3. The detection rate of fQRS in lead aVR of an EKG during the diagnosis ofcoronary multi-vessel disease has some predictive value. |
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