Significance and Usefulness of Narrow Fragmented QRS Complex on 12-Lead Electrocardiogram in Acute ST-Segment Elevation Myocardial Infarction for Prediction of Early Mortality and Morbidity

Abstract

Background:The presence of notched R or S waves without accompanying typical bundle branch blocks, or the existence of an additional wave like RSR' pattern in the original QRS complex (with a duration of <120 ms) has been defined as narrow QRS fragmentation. Persistence of the fQRS found on the admission electrocardiogram (ECG) in patients with acute ST segment elevation myocardial infarction (STEMI) will have prognostic significance in the short term.Methods: The study was carried out using retrospectively collected data of 296 consecutive patients diagnosed as acute STEMI .fQRS group had fQRS both in admission and latest ECGs (n = 80, 27%), and non-fQRS group had no fQRS in last ECG (n = 216, 73%). Primary end points were in-hospital cardiovascular mortality, hemodynamic instability, and electrical instability.Results: MI localization, symptom duration, reperfusion therapy (RPT) rate, RPT modality, rate of successful reperfusion did not differ. Mean ejection fraction was lower and all end points were more frequent in the fQRS group. Irrespective of the RPT modality and success of RPT, mortality rate was higher in patients with persistent fQRS. GRACE score >120 points (OR = 4.765), age >70 years (OR = 4.041), anterior MI localization (OR = 3.148), and presence of fQRS (OR = 2.484) were significant predictors of primary end points. fQRS increased the predictive ability of GRACE score >120 about two folds (OR = 7.305, P < 0.001).Conclusion: Persistent fQRS on ECG is associated with poor prognosis and there is a lack of expected mortality benefit of RPT, particularly that of fibrinolytic therapy, in STEMI patients with fQRS.

The Predictive Value of Fragmented QRS and QRS Distortion for High-Risk Patients with STEMI and for the Reperfusion Success

“…Although three vessels disease was significantly higher in group 1, there was no such relationship between QRS distortion and three vessels disease, as has been previously reported. 10,21,22 Our study confirms the relationship between fQRS and three vessels disease first reported by Stavileci et al 22 In contrast to our findings, Ari et al 23 reported that there was no relationship between fQRS and three vessels disease. This may be because that study had a lower number of patients (85 patients) and only included patients who underwent primary PCI.…”

Assessment of the relationship between a narrow fragmented QRS complex and coronary slow flow

“…The presence of fQRS has been demonstrated to be an independent predictor of impaired myocardial perfusion and left ventricular function detected by myocardial single-photon emission computed tomography imaging in patients with ischemic heart disease [9,22,23]. Moreover, fQRS, which may be widened or narrowed, has been reported to be related with a high incidence of major adverse cardiovascular events, including mortality due to hemodynamically significant ventricular arrhythmic events in CAD, acute coronary syndromes [24,25], hypertrophic obstructive cardiomyopathy [26], ischemic and non-ischemic cardiomyopathy [27,28], and decompensated systolic heart failure [29]. Moreover, a significant relation between the presence of wide fQRS and the occurrence of CSF was demonstrated by Yilmaz et al [30].…”

Prognostic Value of QRS Fragmentation in Patients with Acute Myocardial Infarction: A Meta‐Analysis

“…9-12, 16, 17 Six studies reported in-hospital adverse events, thus it may be assumed that no cases were lost to follow-up. [13][14][15][16][17][18] In addition, it was not clear how three studies accounted for potential confounders, raising the small possibility of result distortion. 13,15,18 The funnel plot did not suggest evidence of publication bias (Fig.…”

“…[3][4][5][6][7] In addition, various studies have evaluated the prognostic importance of fQRS in patients with acute coronary syndrome (ACS), ST-segment elevation (STEMI), or non-ST segment elevation myocardial infarction (NSTEMI). [8][9][10][11][12][13][14][15][16][17][18] Some recent papers reviewed the clinical importance of fQRS in patients with cardiovascular diseases. [19][20][21] However, the literature regarding the definition and the prognostic value of fQRS in patients with AMI is heterogeneous and the findings are not easy to interpret.…”