Correlation Between Fragmented QRS Wave And Major Adverse Cardiovascular Events In STEMI Patients After Primary Percutaneous Coronary Intervention

Objectives:The purpose of this study was to analyze the fragmentation QRS on surface ecg in patients with ST segment elevation myocardial infarction(STEMI)after the Primary percutaneous coronary intervention(PPCI).The predictive value of fQRS for Major Adverse cardiovascular events(MACE)occurred during the hospitalization of patients.Methods:This study collected 396 patients(95%)from January 2018 to December 2018 who were diagnosed as STEMI at the Hunan Provincial People's Hospital and had emergency PPCI.According to the number of leads with fQRS waves on the surface electrocardiogram of patients at 48 hours after admission,they were divided into group A(no fQRS group,n=195),group B(2 adjacent leads fQRS group,n=96),group C(> 2adjacent leads fQRS group,n=105)three groups.Count data was tested by T test,and measurement data was analyzed by chi-square test or Wilcoxon rank sum test to compare and analyze the baseline data,laboratory data,contrast results,and echocardiogram of the three groups of patients;and the differences in major cardiovascular adverse events during hospitalization.The major cardiovascular adverse events were defined as cardiogenic death,recurrent myocardial infarction,recurrent angina,heart failure,and cardiogenic shock.Receiver operating characteristic(ROC)analysis was used to determine the best cut-off value for the number of leads with fQRS when predicting major cardiovascular adverse events.Logistic regression analysis assessed the correlation between major cardiovascular adverse events and various risk factors.Result:1.The differences in systolic blood pressure(P=0.002),diastolic blood pressure(P=0.015),killip grade(P<0.001)between the three groups of patients were statistically significant,but in the history of smoking,drinking history,hypertension There was no statistically significant difference in medical history,diabetes history and other previous history;the laboratory biochemical indicators NT-proBNP(P<0.001),CK-MB(P = 0.005)and CTnI(P <0.001)levels were significantly different,Differences in other laboratory indicators such as blood lipids and renal function were not statistically significant;angiography results showed that there was a significant difference in the incidence of 3 lesions among the three groups of patients;echocardiographic results showed statistically significant differences in LVEF among the three groups Significance,further analysis found that there were also significant differences in the number of cases with LVEF<40% among the three groups.2.Compared with group A(no fQRS group),patients in group B(2adjacent leads fQRS group)and group C(>2 adjacent leads fQRS group)had higher levels of troponin I and LVEF Low,high incidence of major cardiovascular adverse events in the hospital.Among them,patients in group C(> 2 adjacent leads fQRS group)had a higher incidence of major cardiovascular adverse events during hospitalization.3.ROC curve analysis showed that the fQRS wave of two adjacent leads predicted a major cardiovascular adverse event during hospitalization of PPCI STEMI patients with a sensitivity of 70.0% and a specificity of 73.9%.4.Single factor logistic regression analysis found age,systolic blood pressure,diastolic blood pressure,troponin I,history of hyperlipidemia,LVEF,LVEF <40%,NT-proBNP,urea nitrogen,TG,2 adjacent leadsfQRS,> 2 adjacent leads fQRS,door to ball time are the risk factors for major cardiovascular adverse events during hospitalization,multivariate logistic regression analysis found LVEF,LVEF <40%,2 adjacent leads fQRS,> 2 Adjacent leads f QRS and gateball time are independent predictors of major cardiovascular adverse events during the patient's hospitalization.Conclusion:1.STEMI patients with PPCI during hospitalization have a higher incidence of major cardiovascular adverse events on the surface electrocardiogram of patients with fQRS than patients without fQRS;2.The more lead number of fQRS appeared on the surface electrocardiogram,the worse the prognosis of the patients might be.3.fQRS is an independent risk factor for major cardiovascular adverse events during hospitalization of STEMI patients after PPCI.