ST段抬高型心肌梗死患者介入治疗后碎裂QRS波与新发心房颤动的关系

目的:探讨ST段抬高型心肌梗死(STEMI)患者接受经皮冠状动脉介入术(PCI)后碎裂QRS波(fQRS)与院内新发心房颤动(AF)的关联。方法:171例接受PCI的STEMI患者中24例为新发AF患者(新发AF组),其余147例为无AF患者(无AF组),根据心电图有无fQRS分为fQRS组(n=87)和无fQRS组(n=84)。比较不同组别患者临床特征、心电图和冠状动脉造影参数。结果:女性、糖尿病、高白细胞计数、高C反应蛋白、fQRS及高SYNTAX评分等在新发AF组患者中更为常见(P均<0.05)。fQRS组患者年龄、白细胞计数、C反应蛋白、空腹血糖、多血管病变比例及SYNTAX评分均高于无fQRS组患者(P均<0.05)。fQRS组患者AF发生率明显高于无fQRS组患者(P=0.002)。多因素logistic回归分析显示fQRS是新发AF独立预测因素(OR=3.245,95%CI:1.017~10.253,P=0.043)。结论:存在fQRS的STEMI患者AF发生率高于无fQRS的患者,fQRS是接受PCI的STEMI患者院内新发AF的重要潜在因素。

Association between fragmented QRS and new onset atrial fibrillation in patients with ST segment elevation myocardial infarction after interventional therapy

Objective:To investigate the relationship between the presence of fragmented QRS(fQRS)and in-hospital development of new-onset atrial fibrilation(AF)in patients with ST segment elevation myocardial infarction(STEMI)following percutaneous coronary intervention(PCI).Methods:A total of 171 patients undergoing PCI for STEMI were enrolled,among which 24 patients developed AF and the other 147 patients were designated as the controls.According to the presence or absence of fQRS in ECG,patients were divided into fQRS group(n=87)and none fQRS group(n=84).All clinical characteristics,ECG and coronary angiography parameters were compared between the two groups.Results:The proportion of female,diabetes mellitus and patients with fQRS,leukocyte count,C-reactive protein,and SYNTAX score were higher in patients with new AF(all P<0.05).The age,leukocyte count,C-reactive protein,fasting blood glucose,the proportion of multiple vascular diseases and the SYNTAX score were higher in the fQRS group than none fQRS group(all P<0.05).The incidence of AF in fQRS group was significantly higher than none fQRS group(P=0.002).Multivariate logistic regression analysis demonstrated that the presence of fQRS was the independent predictors of AF(OR=3.245,95%CI 1.017-10.253,P=0.043).Conclusions:Incidence of AF in STEMI patients with fQRS is higher than that in patients without fQRS.fQRS is an important predictor of AF in STEMI after PCI.