Prognostic value of resting high-frequency QRS for clinical outcomes after primary percutaneous coronary intervention in patients with acute ST-segment elevation myocardial infarction: A prospective cohort study

Objectives: The prognostic value of resting high-frequency QRS (HFQRS) for major adverse cardiovascular events after percutaneous coronary intervention (PCI) in ST-segment elevation myocardial infarction patients remains inconclusive. This study aimed to investigate the value of resting HFQRS in evaluating the clinical prognosis of patients with acute myocardial infarction (AMI) after emergency PCI. Methods: In this single-center, prospective cohort study4 (Registration no. ChiCTR2600116159), we enrolled 121 patients with AMI who were treated with emergency PCI in the First Affiliated Hospital of University of Science and Technology of China. The study period spanned from September 2023 to October 2024. Patients were divided into HFQRS positive group (≥ 3 ischemic leads, n = 67) and negative group (≤ 2 ischemic leads, n = 54) according to HFQRS signals within 24 hours post-PCI. The baseline data, laboratory indicators, and incidence of major adverse cardiovascular events (MACE) were collected. Univariate analysis and multivariate Cox proportional hazards regression were applied to identify influencing poor prognosis in AMI patients after emergency PCI. Results: The positive group showed significantly higher age, left atrial/ventricular diameters, N-terminal pro B-type natriuretic peptide levels, and proportion of multi-vessel coronary lesions (all P < 0.05), but lower prevalence of diabetes, lower level of low-density lipoprotein cholesterol, and hemoglobin (all P < 0.05). During follow-up (median 12 months), the MACE incidence was higher in the positive group (55.2% vs . 35.2%, P = 0.028), especially for recurrent angina (32.8% vs. 11.1%, P = 0.005). Cox analysis showed that the number of ischemic leads in HFQRS was an independent risk factor for MACE (hazard ratio [HR] = 1.105, 95% confidence interval [CI]: 1.006-1.214, P = 0.037). Conclusion: Resting HFQRS is an independent predictor of MACE in patients with AMI after PCI, serving as a promising noninvasive tool for prognostic evaluation.