Key result
Presence of fragmented QRS on admission ECG in patients with acute coronary syndrome was associated with a significantly higher in-hospital incidence of major adverse cardiac events.
Why the study?
Does the presence of fragmented QRS on admission ECG predict in-hospital MACE and worse LV function in patients with acute coronary syndrome?
Observational (n=220)
Single-blind
No
Does the presence of fragmented QRS on admission ECG predict in-hospital MACE and worse LV function in patients with acute coronary syndrome?
The presence of fragmented QRS on admission ECG in ACS patients is a useful bedside marker that correlates with myocardial scar, worse LV function, and higher in-hospital MACE.
Background-Rationale of the Study: Among several invasive and non-invasive tests for risk stratification of acute coronary syndromes (ACS), fewer markers can be utilized in clinical practice. Our rationale is to validate use of QRS-fragmentation as a promising bed-side test for assessment of prognosis in those patients. Methods and Results: Collection of two-hundred and twenty patients with ACS was done during two years (from January 2011 till January 2013). Significant organic vaLVe disease and QRS duration ≥ 120 ms as well as patients with permanent pacemakers were excluded. Patients were subjected to full clinical examination, ECG and Echocardiography in the first day of admission followed by diagnostic coronary angiography before discharge and a nuclear study was done for Randomized sample from each group. 12-leads ECG revealed fragmentation of QRS in 74 patients and 146 patients with no QRS fragmentation. Localization of the infarct site revealed NS difference between percentages in both groups. Echocardiography revealed a significant deterioration of LV functions in group-A than group-B. Also, MR jet area was significantly higher in group-A. Coronary angiography revealed severer lesions in group-A more than group-B. Nuclear study revealed higher percentages of irreversible scars in group-A (30%) and higher reversibility in group-B (80%). In-hospital Occurrence of complications from ACS revealed a significant higher incidence of MACE in group-A. Conclusion: Presence of fragmented QRS in surface ECG during ACS represents myocardial scar or fibrosis and reflects the severity of coronary lesions and a correlation between fQRS and depression of LVfunction is established. Indeed, occurrence of MACE is suspected.
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Tarek M. Abdel-Rahman (2013) conducted an observational in Acute Coronary Syndrome (n=220). Fragmented QRS (fQRS) on admission ECG vs. Non-fragmented QRS was evaluated on In-hospital Major Adverse Cardiac Events (MACE) (p=<0.05). Presence of fragmented QRS on admission ECG in patients with acute coronary syndrome was associated with a significantly higher in-hospital incidence of major adverse cardiac events.
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