Association of the Zwolle Score with Fragmented QRS Complex: A Combined Prognostic Tool for Primary Angioplasty in ST Elevation Myocardial Infarctions

Abstract

Introduction: We aimed to introduce the prognostic value of simultaneously calculated fragmented QRS and Zwolle scores as a new scoring system in primary PCI of the STEMI patients. Method: Two hundred fifty-nine STEMI patients were classified as fragmented QRS complex group (fQRS) and non-fragmented QRS complex group (non-fQRS) according to the fragmentation of QRS complex in electrocardiography. These two groups according to whether Zwolle score ≥3 were also classified as high Zwolle score with fQRS complex, high Zwolle score with the non-fQRS complex, the low Zwolle score with fQRS complex, and low Zwolle score with the non-fQRS complex group. The hospitalization data of the patients were analyzed. Results: In the fQRS group compared with the non-fQRS group, wider QRS (105.2±9.7 vs. 88±7.1, p<0,001) as well as the higher Creatin Kinase-MB [med (IQR): 174 (123-199) vs. 102 (96-147), p<0,001] and creatinine (0.99 (0.87-1.2) vs. 0.83 (0.78-0.83), p<0.001) levels were detected. Killip scores of<1 [18(69.2) vs. 8(30.8),p<0.001] were more frequent. Adverse cardiac events were significantly higher in high Zwolle score with fQRS complex group. Conclusion: Clinically, fQRS was associated with high adverse cardiac events ratio. Thus, utilization of Zwolle score along with the fragmented QRS is prognostically significant in primary PCI patients admitted with STEMI.

Predictive value of fragmented QRS for ventricular tachyarrhythmias in patients with acute myocardial infarction: A meta‐analysis

“…From the remaining 12 studies that were reviewed in full text, three studies were not included because their endpoints were commingled with atrioventricular heart‐block or polymorphic ventricular extrasystoles, while another 2 were excluded because VTAs were not their observation endpoints. Unlike other studies investigating VTAs during AMI, the study by Lorgis et al investigated VTAs during long‐term follow‐up (846 ± 297 days) and was excluded for protecting our results against bias. Eventually, there were six cohort studies meeting the predefined eligibility criteria for the further analysis.…”

“…Unlike other studies investigating VTAs during AMI, the study by Lorgis et al investigated VTAs during long‐term follow‐up (846 ± 297 days) and was excluded for protecting our results against bias. Eventually, there were six cohort studies meeting the predefined eligibility criteria for the further analysis.…”

“…The baseline characteristics of the six studies are summarized in Table . Sample sizes of these studies ranged from 216 to 542.…”

“…Two studies reported the duration of QRS complex and revealed that QRS duration in control group was significantly shorter than in case group. All studies reported the data about LVEF, and four studies revealed that LVEF was significantly lower in case group. Nearly 30% of patients in the studies by Attachaipanich et al did not undergo primary PCI.…”

“…Fragmented QRS (fQRS), a unique electrocardiographic (ECG) pattern, was defined by Varriale and Chryssos in 1992 and was proved to be a reliable sign of myocardial infarction scar . A number of studies have shown that AMI patients with fQRS on their ECG are more at risk of a series of complications, such as malignant cardiac arrhythmias, reinfarction and cardiovascular and all‐cause death. However, to date, there has been no systematic review and meta‐analysis to assess the association between fQRS and VTAs of patients with AMI.…”