Fragmented QRS complex predicts contrast‐induced nephropathy and in‐hospital mortality after primary percutaneous coronary intervention in patients with ST‐segment elevation myocardial infarction

Abstract

Background Contrast‐induced nephropathy (CIN) is associated with increased mortality after primary percutaneous coronary intervention (PCI) for ST‐segment elevation myocardial infarction (STEMI). Recently, fragmented QRS complex (fQRS) on 12‐lead electrocardiography has been introduced as a marker of cardiovascular disease and is associated with increased morbidity and mortality. Hypothesis fQRS on ECG is associated with CIN and in‐hospital mortality after primary PCI in patients with STEMI. Methods Eight hundred ninety‐five patients with first STEMI treated by primary PCI were enrolled in the study. Patients were divided into 2 groups according to the presence or absence of fQRS as shown by 12‐lead electrocardiography in the first 24 hours. fQRS was defined by presence of an additional R wave (R″), or notching of the S wave, or >1 R′ in 2 contiguous leads. Patients were then reallocated to 2 groups according to presence or absence of postprocedural CIN, which was defined as a rise in serum creatinine of 0.5 mg/dL or a 25% increase from baseline value within 72 hours after the procedure. Results Patients with a fQRS were older and had significantly lower left ventricular ejection fraction. CIN occurred in 77 (8.6%) patients. The prevalence of CIN and in‐hospital mortality was significantly higher in the fQRS(+) group. In multivariate analysis, fQRS was found to be an independent predictor of CIN (odds ratio: 3.125, P = 0.029) and in‐hospital mortality (odds ratio: 9.062, P = 0.009). Conclusions The fQRS is an independent predictor of postprocedural CIN and in‐hospital mortality in STEMI patients.

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 .…”

High‐volume forced diuresis with matched hydration using the RenalGuard System to prevent contrast‐induced nephropathy: A meta‐analysis of randomized trials

“…However, it has been suggested that several inflammatory markers—including white blood cell count, neutrophil count, C‐reactive protein, big endothelin‐1, and urine neutrophil gelatinase‐associated lipocalin—are also important predictors of CI‐AKI . In addition, fragmented QRS complex on 12‐lead electrocardiography has also been shown to be an independent predictor of postprocedural CIN in patients undergoing primary percutaneous coronary intervention …”

“…16,17 In addition, fragmented QRS complex on 12-lead electrocardiography has also been shown to be an independent predictor of postprocedural CIN in patients undergoing primary percutaneous coronary intervention. 18 Several therapies have been investigated for CIN prevention, Recently, a novel strategy to achieve a high urine output through forced diuresis while maintaining euvolemia has been developed using the RenalGuard system. 20 A possible mechanism by which high urine output through forced diuresis decreases the risk of CIN is by limiting the contrast-nephron exposure time through acceleration of tubule and collecting duct flow, reducing sledging and precipitation of contrast material, clearing the contrast from the kidney before significant damage occurs.…”

Response to Fragmented QRS Complex Predicts Contrast‐Induced Nephropathy and In‐Hospital Mortality After Primary Percutaneous Coronary Intervention in Patients With ST‐Segment Elevation Myocardial Infarction

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We read with great interest the article written by Kurtul and Duran, which was recently published in Clinical Cardiology, demonstrating the role of the fragmented QRS complex (fQRS) as a new predictor of contrast-induced nephropathy and in-hospital mortality after primary percutaneous coronary intervention (PCI) in patients with ST-segment elevation myocardial infarction (STEMI). 1 The authors found that in STEMI patients, fQRS in more than 3 leads on surface electrogram is a strong independent predictor of inhospital mortality, with an odds ratio of 9.062 (95% confidence interval [CI]: 1.722-47.681, P = 0.009) on multivariate analysis. At the same time, fQRS demonstrated to represent an independent predictor of contrast-induced nephropathy (CIN) in patients undergoing PCI for STEMI, with an odds ratio for CIN of 3.125 (95% CI: 1.127-8.695, P = 0.029).

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