Single Derivation Fragmented QRS Can Predict Poor Prognosis in Successfully Revascularized Acute STEMI Patients

Abstract

BackgroundQRS fragmentation (fQRS) is classically defined as the presence of slurred QRS morphology in at least two contiguous leads, and its prognostic importance has been shown in ST elevation myocardial infarction (STEMI). However, no study has investigated the significance of single lead fQRS (sl-fQRS) in surface electrocardiography (ECG).ObjectivesTo evaluate whether sl-fQRS is as valuable as classical fQRS in patients with acute STEMI who had successful revascularization with primary percutaneous coronary intervention (pPCI).MethodsWe included 330 patients with a first STEMI who had been successfully revascularized with pPCI. The patient’s electrocardiography was obtained in the first 48 hours, and the patients were divided into three groups according to the absence of fQRS (no-fQRS); fQRS presence in a single lead (sl-fQRS); and ≥2 leads with fQRS (classical fQRS).ResultsIn-hospital mortality was significantly higher both in patients with sl-fQRS and in patients with ≥ 2 leads with fQRS compared to patients with no-fQRS. In ROC curve analysis, ≥ 1 leads with fQRS yielded a sensitivity of 75% and specificity of 57.4% for the prediction of in-hospital mortality. Multivariate analysis showed that sl-fQRS is an independent predictor of in-hospital mortality (OR: 3.989, 95% CI: 1.237-12.869, p = 0.021).ConclusionsAlthough the concept of at least two derivations is mentioned for the classical definition of fQRS, our study showed that fQRS in only one lead is also associated with poor outcomes. Therefore, ≥1 leads with fQRS can be useful when describing the patients under high cardiac risk in acute STEMI.

Association Between Non-Dipping and Fragmented QRS Complexes in Prehypertensive Patients

“…A narrow fragmented QRS complex (fQRS) on electrocardiography (ECG) is a sign of inhomogeneous and delayed ventricular conduction and is associated with myocardial scarring, fibrosis, and adverse cardiovascular events in various cardiovascular diseases. 5 - 7 It is defined by the presence of notches in the R or S wave in two contiguous leads in one of the major coronary artery territories without a typical bundle branch block and with a QRS duration of < 120 milliseconds. 8 Importantly, increased blood pressure is associated with presence of fQRS on ECG.…”

Fragmented QRS and mortality in patients undergoing percutaneous intervention for ST‐elevation myocardial infarction: Systematic review and meta‐analysis

“…There was no subgroup difference between prospective and retrospective studies ( I 2 = 0%). Subgroup analysis of three studies (Kurtul & Duran, ; Tanriverdi et al., ; Yildirim et al., ) with shorter follow‐up time (in‐hospital or short‐term mortality) still shows significant association (RR 5.58; 95% CI 2.65–11.75) with low heterogeneity ( I 2 = 0%). Funnel plot did not suggest publication bias (Figure ).…”

“…Four studies were excluded because they did not report outcome of interest. Therefore, three retrospective and two prospective cohort studies with 888 fQRS and 1,628 non‐fQRS STEMI patients were included in this meta‐analysis (Akgul et al., ; Kurtul & Duran, ; Tanriverdi, Dursun, Colluoglu, & Kaya, ; Uslu et al., ; Yildirim et al., ). The clinical characteristics are described in Table .…”

“…Tanriverdi et al. () included only patients with successful PCI in their study. We conducted subgroup analyses to examine if these differences would affect the association.…”

Combining fragmented QRS and TIMI score for predicting in-hospital short-term prognosis after acute myocardial infarction

“…Fragmented QRS (fQRS) has been shown to be a valuable electrocardiographic (ECG) index for predicting the prognosis of patients with coronary heart disease (Das et al, 2006(Das et al, , 2007. Also, fQRS is considered to predict an increased likelihood of a poor outcome and mortality in patients with coronary artery disease (CAD) (Güngör et al, 2016), even for some successfully revascularized AMI patients (Tanriverdi et al, 2017;Zhang et al, 2017). So what would happen if fQRS and the TIMI risk score were combined?…”