Korean Circ J.  2012 Oct;42(10):674-683. 10.4070/kcj.2012.42.10.674.

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

• Cetin M
• Kocaman SA
• Kiris T
• Erdogan T
• Canga A
• Durakoglugil ME
• Cicek Y
• Dogan S
• Satiroglu

• KMID: 1826464
• DOI: http://doi.org/10.4070/kcj.2012.42.10.674

Abstract

BACKGROUND AND OBJECTIVES
Fragmented QRS complexes (fQRS) are associated with increased morbidity and mortality. The causative relationship between fQRS and cardiac fibrosis has been shown, but whether the presence and the number of fQRS on admission of electrocardiogram (ECG) predicts ST segment resolution in patients undergoing primary percutaneous coronary intervention (p-PCI) has not been investigated until now.
SUBJECTS AND METHODS
This study included one hundred and eighty-four consecutive patients with ST elevation myocardial infarction (STEMI) who underwent p-PCI. The presence or absence of fQRS on pre and post-PCI ECG and their relation with myocardial infarction and reperfusion parameters were investigated.
RESULTS
Patients with fQRS on admission of ECG or newly developed fQRS after p-PCI had increased inflammatory markers, higher cardiac enzyme levels, increased pain to balloon time, prolonged QRS time, more extended coronary involvement and more frequent Q waves on ECG in comparison to patients with absence or resolved fQRS. The presence and higher number of fQRS on admission or post-PCI ECGs were significantly related with low percent of ST resolution and myocardial reperfusion parameters. The area under the receiver operating characteristics curve values for the presence and number of fQRS to detect Thrombolysis in Myocardial Infarction Blush Grade 0 and 1, were 0.682 and 0.703.
CONCLUSION
In our study, fQRS was significantly related to infarction and myocardial reperfusion parameters before and after p-PCI. Successful myocardial reperfusion by p-PCI caused the reduction in number of fQRS and QRS time with higher ST resolution. fQRS may be useful in identifying the patients at higher cardiac risk with increased ischemic jeopardized or infarcted myocardium, and persistent or newly developed fQRS may predict low percent of ST segment resolution in patients undergoing p-PCI.

Keyword

Fragmented QRS; Electrocardiography; Myocardial infarction; Reperfusion; Marker

MeSH Terms

Electrocardiography
Fibrosis
Humans
Infarction
Myocardial Infarction
Myocardial Ischemia
Myocardial Reperfusion
Myocardium
Percutaneous Coronary Intervention
Reperfusion
ROC Curve

Figure

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  Fig. 1 The various types of notched and fragmented QRS complexes. Different fragmented QRS complexes patterns were shown by arrows including rSr', rSR', RSr', notched R up-stroke, notched S down-stroke, bifid R peak and bifid R nadir.

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  Fig. 2 Changes in fragmented QRS complexes on surface electrocardiogram before and after primary percutaneos coronary intervention.

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  Fig. 3 The sensitivity and the specificity of study parameters to detect Thrombolysis in Myocardial Infarction Blush Grade 0 and 1. ROC: receiver operating characteristics, fQRS: fragmented QRS complexes, PCI: percutaneos coronary intervention, AUC: area under the curve, SE: standard error.

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