Value of fragmented QRS complex combined with red blood cell distribution width in predicting major adverse cardiovascular events in patients with old myocardial infarction
Abstract： Objective To explore the value of fragmented QRS complex (fQRS), red blood cell distribution width (RDW) and their combination in predicting major adverse cardiovascular events(MACE) among patients with old myocardial infarction (OMI). Methods The clinical data of 530 patients with OMI were analyzed retrospectively. According to the presence or absence of fQRS, they were divided into fQRS positive group and fQRS negative group. The influencing factors of fQRS positive results were analyzed by Logistic regression. These patients were divided into MACE group and nonMACE group according to whether MACE had occurred during follow-up. Multivariate Logistic regression analysis was used to analyze the independent risk factors of MACE in patients with OMI. By drawing receiver operating characteristic curve (ROC curve), the predicting efficiency of fQRS and RDW on the occurrence of MACE in OMI patients was analyzed. Results Multivariate Logistic regression analysis showed that fQRS was more likely to be found in patients with high RDW (OR=2.757, 95%CI 1.961-3.877, P<0.05); positive fQRS (OR=2.719, 95%CI 1.619-4.566), complicated hypertension (OR=2.147, 95%CI 1.212-3.803), left atrial diameter (OR=1.100, 95%CI 1.039-1.164), increased RDW (OR=1.909, 95% CI 1.463-2.575), decreased LVEF(OR=0.933, 95%CI 0.894-0.973), increased Gensini Score (OR=1.038, 95% CI 1.024-1.053), and increased ALT (OR=0.998, 95%CI 1.002-1.027) were independent risk factors for MACE in patients with OMI (P<0.05). ROC curve analysis showed that fQRS had predictive value on heart failure, recurrent angina pectoris, target vessel hemodynamic disorder, malignant arrhythmias and cardiogenic death (P<0.05), with an area under curve (AUC) of 0.617, 0.682, 0.696, 0.652 and 0.672, respectively. RDW has predictive value on recurrent angina pectoris, target vessel hemodynamic disorder, malignant arrhythmias and cardiogenic death (P<0.05), with an AUC of 0.717, 0.804, 0.673 and 0.809, respectively. The AUC of fQRS, RDW, LVEF, fQRS combined with RDW, RDW combined with LVEF, fQRS combined with LVEF, and the combination of the three indexes in predicting the occurrence of MACE were separately 0.687, 0.729, 0.670, 0.756, 0.778, 0.762 and 0.798. ConclusionRDW is an influencing factor of fQRS positive results. The higher the RDW, the higher the positive rate of fQRS in OMI patients. The predictive value of fQRS, RDW and LVEF are relatively high for MACE in patients with OMI; the predictive values of either of the two indexes and the combination of the three indexes are higher. Among them, fQRS is more valuable in predicting target vessel hemodynamic disorder while RDW is more valuable in predicting cardiogenic death in patients with OMI.
赵新悦,李元民,肖强,郭慧梅. 碎裂QRS波联合红细胞分布宽度对陈旧性心肌梗死患者主要不良心血管事件的预测价值[J]. 实用心电学杂志, 2024, 33(3): 250-257.
ZHAO Xinyue, LI Yuanmin, XIAO Qiang, GUO Huimei. Value of fragmented QRS complex combined with red blood cell distribution width in predicting major adverse cardiovascular events in patients with old myocardial infarction. JOURNAL OF PRACTICAL ELECTROCARDIOLOGY, 2024, 33(3): 250-257.
