The prognostic significance of a fragmented QRS complex after primary percutaneous coronary intervention

Abstract

Fragmented QRS (fQRS) may occur due to non-homogeneous activation of ischemic ventricles. We want to investigate the prognostic significance of a fQRS complex in a patient who had undergone primary percutaneous coronary intervention (PCI). Eighty-five patients with no history of coronary artery disease who underwent primary PCI were included in the study. Of these patients, 34 who were found to have a fQRS at the 48th hour after primary PCI were defined as group 1, and 51 who were found not to have a fQRS were defined as group 2. Both groups were monitored for adverse cardiac events. At 6.6 ± 2.3 months of follow-up, major adverse cardiac events (MACE) was found significantly higher in the fQRS group [group 1:10 (29.4%) vs. group 2:3 (5.9%); p:0.003]. In multivariate Cox regression analysis; the duration of chest pain (HR:1.02, CI:1.004-1.05; p = 0.03) and fQRS at 48th hour (HR 7.16, CI 3.17-20.11; p = 0.006) were predictors of MACE. In the group 2, event-free survival rate was found significantly higher; however, Q wave and QRS distortion were found to be insignificant with regard to demonstrating event-free survival. Compared to both Q wave and QRS distortion, fQRS showed high sensitivity and specificity in demonstrating MACE (sensitivity 0.77; specificity 0.67; AUC 0.71 (0.57-0.86); p 0.01). fQRS had 73% sensitivity and 49% specificity and Q wave had 58% sensitivity and 85% specificity for demonstrating the presence of scar on myocardial perfusion scintigraphy with ROC curve analysis. The presence of a fQRS at the 48th hour is a significant predictor of MACE in patients with ST elevation myocardial infarction who have undergone primary PCI. (ClinicalTrials.gov number: NCT01136837).

Fragmentation of the QRS complex in patients with acute coronary syndrome treated invasively

“…Fragmenta- on f-QRS, often appearing in the application, was associated with a higher risk of VT/VF in patients with acute MI, including those with primary PCI [11]. One of the studies of f-QRS has shown that in the short-term follow-up of patients after ACS, who underwent PCI and were f-QRS-negative, no statistically significant differences were found in the growth of malignant cardiac arrhythmias compared with the patients who underwent PCI and their fragmentation was presented [3]. This study did not indicate, however, whether PCI was completed to fully restore the flow.…”

“…The same applied to conduction disturbances. In contrast, Ari et al [3] demonstrated that the presence of f-QRS in 48-h ACS is an important marker of severe cardiac events in patients with acute MI, who were subjected to primary PCI [4]. It was one of the first studies that took the effective PCI into account, but included only a small group of STEMI patients.…”

“…In the tion of narrow QRS (< 120 ms) is defined as an additional R (R') wave or an incision within the S wave or the presence of at least 2 R-waves in two contiguous leads corresponding to the area by the relevant vasculature coronary artery [9]. The presence of f-QRS ECG was associated with a heterogeneous, "zig-zag" scar formed around the conduction within the myocardium [3]. Earlier studies have shown that f-QRS is a valuable predictor of MI, malignant cardiac arrhythmias, left ventricular dysfunction, and coronary artery ectasia [9,10].…”

“…In recent years, numerous studies have indicated that such a marker of life-threatening rhythms in the course of ACS may be the presence of fragmentation within the QRS (f-QRS) in the electrocardiogram (ECG) ACS [1]. According to many researchers, f-QRS is considered to be a predictor for recurrence of severe cardiac events and high mortality, and is an indicator of early intervention treatment for patients [3]. No one has previously analysed the presence of f-QRS in patients after myocardial infarction (MI) and complete revascularisation [4,5].…”

“…No one has previously analysed the presence of f-QRS in patients after myocardial infarction (MI) and complete revascularisation [4,5]. In turn, the rapid restoration of coronary artery patency and the flow of the microcirculation are the basis of minimising serious complications after MI [3,6,7]. Therefore, the aim of this study is to assess the relationship between the frequency of f-QRS and the occurrence of arrhythmias in patients with ACS, who underwent successful revascularisation, in a short-term observation.…”