Fragmented QRS complex in acute coronary syndrome, does it have significance in the emergency room? A study from Egypt

Background: Fragmented QRS (fQRS) is derived from regional myocardial fibrosis/scar and ischemia, which cause heterogeneous myocardial electrical activation. We aimed to detect if the presence of fQRS can predict the presence of coronary artery disease (CAD) and to which extent in Egyptian patients with acute coronary syndrome (ACS). Materials and Methods: Seventy-four patients with ACS were divided into two groups according to the presence of fQRS in the initial and follow-up electrocardiography (ECG), they underwent clinical examination, full history for CAD risks, echocardiographic study, cardiac enzymes, lipid profile estimation, and coronary angiographic study. Results: FQRS, when compared with pathological Q wave and ST-segment depression for diagnosis CAD; it has higher sensitivity (49.0% vs. 36.7% and 17.3%) for left anterior descending artery (LAD), (66.7% vs. 14.3% and 9.5%) for left circumflex (LCX), (67.5% vs. 27.5% and 12.5%) for right coronary artery (RCA), more specific (92.00% vs. 78.2% and 80%) for LAD, higher positive predictive value (45% vs. 39.2% and 35.9%) for LAD, (77% vs. 50% and 22%) for LCX, (90% vs. 73.3% and 38.5%) for RCA, more accuracy (63.5% vs. 51.4% and 41.9%) for LAD, (85.1% vs. 71.6% and 64.8%) for LCX, and (78.4% vs. 55.4% and 41.9%) for RCA with a statistically significant differences (P < 0.05). Conclusions: Presence of fQRS in ECG is a good, simple, applicable positive test to predict the presence of significant CAD in the Egyptian patients with ACS in the emergency room, even in those without enzyme elevation but have “fQRS.”