Combining Fragmented QRS And GRACE Score For Predicting In-hospital And Short-term Major Adverse Cardiovascular Events In Patients With Acute Non-ST-elevation Myocardial Infarction

Objective:To explore the predictive value of fragmented QRS(fQRS)on admission combined with The Global Registry of Acute Coronary Events(GRACE)risk score for major adverse cardiovascular Events during hospitalization and 6 months in patients with non-ST-segment elevation myocardial infarction(NSTEMI).The major adverse cardiovascular events in this study were defined as cardiac death,malignant arrhythmia,heart failure,and reinfarction/angina rehospitalization events.Methods:A total of 422 patients with NSTEMI who were admitted to the Department of Cardiology of SuBei Hospital during June 1,2018 and May 31,2020 were included.According to the inclusion and exclusion criteria,344 patients were included in the study,including 145 in the fQRS group and 199 in the non-fQRS group.The electrocardiogram,baseline data,biochemical results,and left ventricular ejection fraction(LVEF)were collected by medical record system on admission.Read the angiography results and collect the coronary artery lesions;Cardiac death,malignant arrhythmias,heart failure,reinfarction/angina rehospitalization events during hospitalization and within 6 months were followed up by inpatient and outpatient medical records or by telephone.SPSS23.0 software was used to perform a joint logistic regression analysis of fQRS and GRACE levels.Then,with cardiac death,malignant arrhythmia,heart failure,reinfarction/angina rehospitalization events as outcome variables,SPSS23.0 software was used to plot the Receiver operating characteristic curve(ROC)of fQRS,GRACE score and the combination of the two.MedCalc 19.6 software was used to compare the Areas under the Curve(AUC).Results:1.344 patients with NSTEMI were followed up for 5.55±1.37 months.There were 68(19.8%)cases of heart failure,44(12.8%)cases of reinfarction/angina rehospitalization,24(7%)cases of cardiac death,and 22(6.4%)cases of malignant arrhythmia during hospitalization and within 6 months.The incidence of heart failure,reinfarction/angina rehospitalization,cardiac death and malignant arrhythmia in fQRS group were significantly higher than those in non-fQRS group(P<0.05 for each group).2.In terms of the predictive value of short-term cardiac death in NSTEMI patients,the AUC of the fQRS group is 0.609(95%CI 0.556-0.661),the GRACE grade group 0.735(95%CI 0.685-0.781),and the combination group 0.748(95%CI 0.698-0.793).The AUC of three groups are compared.The AUC of the combination group is larger than that of GRACE grade group,with no significant difference.The AUC of the combination group is significantly larger than that in the fQRS group(P<0.001).3.In terms of the predictive value of short-term malignant arrhythmias in NSTEMI patients,the AUC of the fQRS group is 0.615(95%CI 0.561--0.666),the GRACE grade group 0.689(95%CI 0.637--0.737),and the combination group 0.728(95%CI 0.678-0.775).The AUC of three groups are compared.The AUC of the combination group is larger than that of the GRACE grade group,with no significant difference.The AUC of the combination group is significantly larger than that in the fQRS group(P=0.004).4.In terms of the predictive value of short-term heart faliure in NSTEMI patients,the AUC of the fQRS group is 0.650(95%CI 0.597--0.700),the GRACE grade group 0.689(95%CI 0.637-0.737),and the combination group 0.753(95%CI 0.704-0.798).The AUC of three groups are compared.The AUC of the combination group is larger than that of the fQRS group(P=0.019)and the GRACE grade group(P<0.001).5.In terms of the predictive value of short-term reinfarction/angina rehospitalization in NSTEMI patients,the AUC of the fQRS group is 0.701(95%CI 0.650-0.749),the GRACE grade group 0.605(95%CI 0.551-0.657),and the combination group 0.753(95%CI 0.704-0.797).The AUC of three groups are compared.The AUC of the combination group is larger than that of the fQRS group(P=0.005)and the GRACE grade group(P<0.001).Conclusions:(1)fQRS wave,GRACE degree and the combination of the two can predict short-term cardiac death,malignant arrhythmia,heart failure,and reinfarction/angina rehospitalization events in patients with NSTEMI.(2)The combinition of fQRS and GRACE degree for short-term heart failure and reinfarction/angina readmission in patients with NSTEMI have a higher predictive value compared with the fQRS and GRACE degree respectively.(3)The predictive sensitivity of fQRS combined with GRACE degree to short-term cardiac death in NSTEMI patients is higher than that of fQRS and GRACE rating respectively.The predictive value of fQRS combined with GRACE degree for short-term malignant arrhythmias in patients with NSTEMI was superior to fQRS alone.