A single-center study of the relationship between QRS duration of first medical contact and clinical endpoint in acute ST-segment elevation myocardial infarction

doi:10.11958/20241504

Abstract

Abstract:

Objective To evaluate the relationship between the QRS duration (QRSd) of the first medical contact (FMC) and the 30-day clinical endpoint of acute ST-segment elevation myocardial infarction (STEMI). Methods A total of 547 STEMI patients were selected and divided into the QRSd < 100 ms group (306 cases) and the QRSd≥100 ms group (241 cases). Clinical data of the patients were collected, and electrocardiography (ECG) and cardiac ultrasound were evaluated according to the FMC examination results of patients. The starting point of the study was the postoperative day. Outpatient or telephone follow-up was performed after discharge until 30 days or death, the primary endpoint was major adverse cardiovascular events (MACE), which was defined as the composite endpoint of all-cause mortality, acute heart failure (AHF) and revascularization again, and the secondary endpoint was AHF. Kaplan-Meier curves were drawn to evaluate the incidence rates of MACE and AHF. QRSd was included in Cox regression with continuous variables and categorical variables to analyze influence factors of 30-day MACE and AHF in STEMI patients. The receiver operating characteristic (ROC) curve was used to evaluate the efficacy of QRSd in predicting 30 d MACE occurrence in STEMI patients.Results Compared with the QRSd < 100 ms group, HR was faster and the proportion of smoking history was lower in the QRSd≥100 ms group (P<0.05). MACE occurred in 44 patients, including 11 in the QRSd < 100 ms group and 33 in the QRSd≥100 ms group. AHF occurred in 17 patients, including 2 patients in the QRSd < 100 ms group and 15 patients in the QRSd≥100 ms group. Kaplan-Meier survival analysis showed that the incidence of MACE and AHF were higher in the QRSd≥100 ms group than those in the QRSd < 100 ms group (P<0.01). Multivariate Cox regression analysis showed that prolonged QRSd and QRSd≥100 ms were risk factors for MACE and AHF (P<0.05). ROC curve results showed that the best cutoff value of QRSd for predicting MACE was 111 ms, the area under the curve (AUC) was 0.796 (95%CI: 0.710-0.881), the sensitivity was 0.75, and the specificity was 0.84.Conclusion Compared with QRSd <100 ms, QRSd ≥100 ms of the FMC can increase the risk of 30-day MACE and heart failure in patients with STEMI, and this risk increases with prolonged QRSd.

Key words: ST elevation myocardial infarction, electrocardiography, heart failure, QRS duration, major adverse cardiovascular events, first medical contact

CLC Number:

R542.22，R540.41

Figures/Tables 10

References 12

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组别	n		年龄/岁		发病时间/h	SCr/（μmol/L）			HR/（次/min）		BNP/（ng/L）			LVEF
QRSd<100 ms组	306		63.0（53.0，71.0）		2.0（1.0，4.0）	72.00（61.00，82.14）			72.0（63.0，83.0）		125.14（44.10，273.54）			0.490（0.450，0.530）
QRSd≥100 ms组	241		63.0（53.0，70.0）		2.5（1.5，4.0）	77.00（63.55，91.00）			76.0（63.0，90.0）		131.12（46.66，302.06）			0.480（0.425，0.530）
Z或χ²			0.042		1.745	2.803			5.658^＊		0.088			2.470
组别		TC/（mmol/L）		LDL-C/（mmol/L）			Hb/（g/L）	高血压		2型糖尿病		陈旧性脑梗死	吸烟史		冠心病史
QRSd<100 ms组		4.63（4.01，5.34）		3.03（2.56,3.64）			138.58±18.64	180（58.8）		96（31.4）		39（12.7）	147（48.0）		26（8.5）
QRSd≥100 ms组		4.56（3.87，5.33）		3.02（2.31，3.68）			138.71±18.28	147（61.0）		77（32.0）		33（13.7）	94（39.0）		26（10.8）
t、Z或χ²		0.437		0.002			0.083	0.265		0.021		0.106	4.465^＊		0.823

组别	n		年龄/岁		发病时间/h	SCr/（μmol/L）			HR/（次/min）		BNP/（ng/L）			LVEF
QRSd<100 ms组	306		63.0（53.0，71.0）		2.0（1.0，4.0）	72.00（61.00，82.14）			72.0（63.0，83.0）		125.14（44.10，273.54）			0.490（0.450，0.530）
QRSd≥100 ms组	241		63.0（53.0，70.0）		2.5（1.5，4.0）	77.00（63.55，91.00）			76.0（63.0，90.0）		131.12（46.66，302.06）			0.480（0.425，0.530）
Z或χ²			0.042		1.745	2.803			5.658^＊		0.088			2.470
组别		TC/（mmol/L）		LDL-C/（mmol/L）			Hb/（g/L）	高血压		2型糖尿病		陈旧性脑梗死	吸烟史		冠心病史
QRSd<100 ms组		4.63（4.01，5.34）		3.03（2.56,3.64）			138.58±18.64	180（58.8）		96（31.4）		39（12.7）	147（48.0）		26（8.5）
QRSd≥100 ms组		4.56（3.87，5.33）		3.02（2.31，3.68）			138.71±18.28	147（61.0）		77（32.0）		33（13.7）	94（39.0）		26（10.8）
t、Z或χ²		0.437		0.002			0.083	0.265		0.021		0.106	4.465^＊		0.823

变量	β	SE	Wald χ²	P	HR（95%CI）
QRSd（连续变量）	0.064	0.007	89.378	<0.001	1.066（1.052~1.081）
QRSd（分类变量）	1.375	0.348	15.599	<0.001	3.956（1.999~7.827）

变量	β	SE	Wald χ²	P	HR（95%CI）
QRSd（连续变量）	0.064	0.007	89.378	<0.001	1.066（1.052~1.081）
QRSd（分类变量）	1.375	0.348	15.599	<0.001	3.956（1.999~7.827）

变量	β	SE	Wald χ²	P	HR（95%CI）
QRSd（连续变量）	0.074	0.010	58.006	<0.001	1.076（1.056~1.097）
QRSd（分类变量）	2.278	0.753	9.159	0.002	9.759（2.232~42.676）