Tanriverdi Z, Dursun H, Colluoglu T, Kaya D. Single Derivation Fragmented QRS Can Predict Poor Prognosis in Successfully Revascularized Acute STEMI Patients.
Arq Bras Cardiol 2017;
109:213-221. [PMID:
28746519 PMCID:
PMC5586228 DOI:
10.5935/abc.20170099]
[Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Accepted: 03/23/2017] [Indexed: 12/31/2022] Open
Abstract
Background
QRS fragmentation (fQRS) is classically defined as the presence of slurred
QRS morphology in at least two contiguous leads, and its prognostic
importance has been shown in ST elevation myocardial infarction (STEMI).
However, no study has investigated the significance of single lead fQRS
(sl-fQRS) in surface electrocardiography (ECG).
Objectives
To evaluate whether sl-fQRS is as valuable as classical fQRS in patients with
acute STEMI who had successful revascularization with primary percutaneous
coronary intervention (pPCI).
Methods
We included 330 patients with a first STEMI who had been successfully
revascularized with pPCI. The patient’s electrocardiography was obtained in
the first 48 hours, and the patients were divided into three groups
according to the absence of fQRS (no-fQRS); fQRS presence in a single lead
(sl-fQRS); and ≥2 leads with fQRS (classical fQRS).
Results
In-hospital mortality was significantly higher both in patients with sl-fQRS
and in patients with ≥ 2 leads with fQRS compared to patients with
no-fQRS. In ROC curve analysis, ≥ 1 leads with fQRS yielded a
sensitivity of 75% and specificity of 57.4% for the prediction of
in-hospital mortality. Multivariate analysis showed that sl-fQRS is an
independent predictor of in-hospital mortality (OR: 3.989, 95% CI:
1.237-12.869, p = 0.021).
Conclusions
Although the concept of at least two derivations is mentioned for the
classical definition of fQRS, our study showed that fQRS in only one lead is
also associated with poor outcomes. Therefore, ≥1 leads with fQRS can
be useful when describing the patients under high cardiac risk in acute
STEMI.
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