22Apr 2017

IMPACT OF QRS COMPLEX FRAGMENTATION ON HOSPITAL OUTCOME OF PATIENTS UNDERGOING PRIMARY PERCUTANEOUS CORONARY INTERVENTION.

  • Cardiology Department, Faculty of Medicine-Zagazig University, Egypt.
Crossref Cited-by Linking logo
  • Abstract
  • References
  • Cite This Article as
  • Corresponding Author

Background and Aim: Fragmented QRS (fQRS) was linked to myocardial ischemia and scar. The aim of this study was to investigate the impact of fQRS on the hospital outcome and major adverse cardiac events (MACE) in patients with acute STEMI treated with primary percutaneous coronary intervention (PCI). Methods: The present study was conducted on 90 patients with acute STEMI and treated with primary PCI, in Zagazig University Hospital in Egypt, during the period from January 2015 to May 2016. Careful history taking, clinical data, full lab, left ventricular ejection fraction calculated by biplane Simpson method and angiographic findings were taken. ECG records were obtained on admission and 2 hours after primary PCI. During hospitalization, ventricular fibrillation (VF) and ventricular tachycardia (VT), cardiogenic shock, cardiopulmonary resuscitation, re-infarction, and death were regarded as MACE. We divided the patients into 2 groups as regard fQRS on admission ECG into fragmented (n=40) group and non-fragmented (n=50) group. Results: There was significant statistical difference regarding in-hospital AF, being more frequent in fQRS group (P value 0.049). There was significant statistical difference regarding LVEF, being lower in fQRS group (P value 0.009). There was significant statistical difference regarding the incidence of three vessel disease, being more frequent in fQRS group (P value 0.02). There was significant statistical difference regarding culprit lesion being proximal, being more frequent in fQRS group (p value 0.009). By multivariate analysis, we found that fQRS was a predictor for unfavorable hospital outcome (P value 0.046) Conclusions: Assessment of fQRS by ECG is a simple, widely available, and noninvasive modality that may be useful to predict hospital outcome, incidence of proximal and three vessels disease in patients with acute STEMI undergoing primary PCI.

  1. Wang Y and Zhao HN. Investigation of changing and significance of connexin43, [Ca2+] and apoptosis in early phase of acute myocardial ischemia. Chin J Cardiac Pacing Electrophysiol. 2011; 4(25):349?352.
  2. Das MK. Significance of a fragmented QRS complex versus a Q wave in patients with coronary artery disease. Circulation. 2006; 113:2495.
  3. Das MK. Fragmented wide QRS on a 12-lead ECG: a sign of myocardial scar and poor prognosis. Circ Arrhythm Electrophysiol. 2008; 1:258.
  4. Cheema A, Khalid A, Wimmer A, et al. Fragmented QRS and mortality risk in patients with left ventricular dysfunction. Circ Arrhythm Electrophysiol. 2010; 3(4):339?344.
  5. Pietrasik G and Zareba W. QRS Fragmentation: Diagnostic and prognostic significance. Cardiol J. 2012; 19(2):114?21.
  6. Das MK. Fragmented QRS on a 12-lead ECG: a predictor of mortality and cardiac events in patients with coronary artery disease. Heart Rhythm. 2007; 4:1385.
  7. Korhonen P. Fragmented QRS in prediction of cardiac deaths and heart failure hospitalizations after myocardial infarction. Ann Noninvasive Electrocardiol. 2010; 15:130.
  8. Bayes de Luna A. Electrographic patterns of ischemia, injury and necrosis. Clinical electrocardiography: A textbook. 2nd ed. Futura Publishing Company, Inc.; Armonk, NY: 1998. pp. 141?42.
  9. Ma X, Duan W, Poudel P, et al. Fragmented QRS complexes have predictive value of imperfect ST-segment resolution in patients with STEMI after primary percutaneous coronary intervention. Am J Emerg Med. 2016 Mar; 34(3):398-402.
  10. Yıldırım E, Kara?imen D, Ozcan KS, et al. The relationship between fragmentation on electrocardiography and in-hospital prognosis of patients with acute myocardial infarction. Med Sci Monit. 2014 Jun 3; 20:913-9.
  11. Cetin M, Kocaman SA, Kiris T, et al. Absence and resolution of fragmented QRS predict reversible myocardial ischemia with higher Probability of ST segment resolution in patients with ST segment elevation myocardial infarction. Korean Circ J. 2012 Oct; 42(10):674-83.
  12. Uslu N, Gul M, Cakmak HA, et al. The assessment of relationship between fragmented QRS complex and left ventricular wall motion score index in patients with ST elevation myocardial infarction who underwent primary percutaneous coronary intervention. Ann Noninvasive Electrocardiol. 2015 Mar; 20(2):148-57.
  13. Tanriverdi Z, Dursun H, Simsek MA, et al. The Predictive Value of Fragmented QRS and QRS Distortion for High-Risk Patients with STEMI and for the Reperfusion Success. Ann Noninvasive Electrocardiol. 2015 Nov; 20(6):578-85.

[Hatem Badawi, Ragab mahfouz, Tamer Moustafa and Marwa Gad. (2017); IMPACT OF QRS COMPLEX FRAGMENTATION ON HOSPITAL OUTCOME OF PATIENTS UNDERGOING PRIMARY PERCUTANEOUS CORONARY INTERVENTION. Int. J. of Adv. Res. 5 (Apr). 215-221] (ISSN 2320-5407). www.journalijar.com

Hatem Sayed Ahmed Mohamed Badawi
Cardiology Department, Faculty of Medicine-Zagazig University, Egypt.

DOI:

Article DOI: 10.21474/IJAR01/3798      
DOI URL: http://dx.doi.org/10.21474/IJAR01/3798

Download Full Paper

Download PDF No. of Downloads: 16 | No. of Views: 73