Korean J Intern Med.  2017 May;32(3):469-477. 10.3904/kjim.2015.123.

Fragmented QRS and abnormal creatine kinase-MB are predictors of coronary artery disease in patients with angina and normal electrocardiographys

• Lee JJ
• Lee JH
• Jeong JW
• Chung JY

• KMID: 2379477
• DOI: http://doi.org/10.3904/kjim.2015.123

Abstract

BACKGROUND/AIMS
Patients with symptoms of coronary artery disease (CAD) often display normal tracings or only nonspecific changes on electrocardiography (ECG). The aim of this study was to explore strategic elements of the ECG and other potential factors that are predictive of CAD in this scenario.
METHODS
This was an observational study of 142 patients with the chief complaint of chest pain, each of whom presented with a normal ECG and was subjected to emergency coronary angiography (CAG). Two population subsets were identified: those patients (n = 97) with no significant stenotic lesions and those (n = 45) with the significant stenotic lesions of CAD.
RESULTS
Those patients with normal or nonspecific ECGs and CAD (15.8%) were more likely to have left circumflex artery involvement (20% vs. 7%). In patients with normal ECGs and CAD (vs. normal CAG), male sex (86.7% vs. 68%, p = 0.023), creatine kinase-MB (CK-MB) levels > 10 U/L (13 vs. 10, p = 0.025), and fragmented QRS (fQRS) (38.6% vs. 21.6%, p = 0.042) occurred with greater frequency. In multivariable analysis, the following variables were significant predictors of CAD, given a normal ECG: male sex (odds ratio [OR], 2.593; 95% confidence interval [CI], 1.068 to 5.839); CK-MB (OR, 2.497; 95% CI, 0.955 to 7.039); and W- or M-shaped QRS complex (OR, 2.306; 95% CI 0.988 to 5.382).
CONCLUSIONS
In our view, male sex, elevated CK-MB (> 10 U/L), and fQRS complexes are suspects for CAD in patients with angina and unremarkable ECGs and should be considered screening tests.

Keyword

Coronary disease; Myocardial infarction; Electrocardiography; Angiography

MeSH Terms

Angiography
Arteries
Chest Pain
Coronary Angiography
Coronary Artery Disease*
Coronary Disease
Coronary Vessels*
Creatine*
Electrocardiography
Emergencies
Humans
Male
Mass Screening
Myocardial Infarction
Observational Study
Creatine