Archives of the Turkish Society of Cardiology
Relationship between presence of fragmented QRS on 12-lead electrocardiogram on admission and long-term mortality in patients with non-ST elevated myocardial infarction [Turk Kardiyol Dern Ars]
Turk Kardiyol Dern Ars. 2014; 42(8): 726-732 | DOI: 10.5543/tkda.2014.79438

Relationship between presence of fragmented QRS on 12-lead electrocardiogram on admission and long-term mortality in patients with non-ST elevated myocardial infarction

Adem Bekler1, Emine Gazi1, Gökhan Erbağ2, Tezcan Peker3, Ahmet Barutçu1, Burak Altun1, Ahmet Temiz1, Mustafa Yılmaz1
1Department of Cardiology, Onsekiz Mart University Faculty of Medicine, Çanakkale
2Department of Internal Medicine, Canakkale Onsekiz Mart University Faculty of Medicine, Canakkale
3Department of Cardiology, Bursa Yüksek Ihtisas Training and Research Hospital, Bursa


OBJECTIVES
Fragmented QRS (fQRS) as a predictor of cardiac events in coronary artery disease has previously been reported. In this study, we hypothesized that presence of fQRS on a 12-lead electrocardiogram (ECG) on admission would be predictive of adverse outcomes in non-ST elevated myocardial infarction (NSTEMI).

STUDY DESIGN
A total of 149 NSTEMI patients (112 male, 37 female) were retrospectively analyzed. The fQRS pattern was defined as the presence of an additional R’, notching in the nadir of the S wave, fragmentation of the RS or QS complexes in 2 contiguous leads corresponding to a major coronary artery territory. The relationship between presence of fQRS on admission on a 12-lead ECG, and primary end points [cardiovascular death (CVD)] and secondary end points (re-infarction, repeat target vessel revascularization [percutaneous/surgical]) were assessed. The median follow-up time was 18 (13-24) months.

RESULTS
Other than age, there were no significant differences in baseline characteristics and laboratory findings for patients in the fQRS and non-fQRS groups. The patients in the fQRS group were older [64 years vs 59 years, p=0.048]. CVD and re-infarction were significantly higher in the fQRS group in the median 18-month follow-up (26.1% vs 8.7%, p=0.005; 23.9% vs 10.7%, p=0.035, respectively). By a multivariate regression analysis in all 149 patients, age ≥65 years and the presence of fQRS in a 12-lead ECG on admission were found to be powerful independent predictors of cardiovascular mortality (HR: 4.91, 95% CI: 1.60-15.03, p=0.005; HR: 2.77, 95% CI: 1.02-7.50, p=0.044, respectively).

CONCLUSION
Presence of fQRS on a 12-lead ECG on admission is associated with increased long-term mortality in patients with NSTEMI.

Keywords: Acute coronary syndrome, fragmented QRS, myocardial infarction, mortality

How to cite this article
Adem Bekler, Emine Gazi, Gökhan Erbağ, Tezcan Peker, Ahmet Barutçu, Burak Altun, Ahmet Temiz, Mustafa Yılmaz. Relationship between presence of fragmented QRS on 12-lead electrocardiogram on admission and long-term mortality in patients with non-ST elevated myocardial infarction. Turk Kardiyol Dern Ars. 2014; 42(8): 726-732

Corresponding Author: Adem Bekler, Türkiye
Manuscript Language: English
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