Key result
Fragmented QRS was associated with an increased risk of sudden cardiac death (RR 2.20; 95% CI 1.05-4.62) and all-cause mortality (RR 1.71; 95% CI 1.02-2.85).
Why the study?
Does the presence of fragmented QRS predict all-cause mortality and sudden cardiac death in patients with coronary artery disease or non-ischaemic cardiomyopathy?
Meta-Analysis (n=5,009)
Does the presence of fragmented QRS predict all-cause mortality and sudden cardiac death in patients with coronary artery disease or non-ischaemic cardiomyopathy?
Relative Risk: 2.2 (95% CI 1.05–4.62)
Fragmented QRS on ECG is a significant non-invasive predictor of all-cause mortality and sudden cardiac death in patients with coronary artery disease or non-ischemic cardiomyopathy.
May aid non-invasive SCD risk stratification in CAD/NICM; extends meta-analytic support but leaves prospective validation open.
AIMS: Risk stratification of sudden cardiac death (SCD) is challenging. Fragmented QRS (fQRS) is proposed as a non-invasive electrocardiogram marker associated with mortality and SCD. Results from individual studies including small numbers of patients are discrepant. We therefore performed a meta-analysis of studies evaluating fQRS as a risk stratification tool to predict all-cause mortality and SCD. METHODS AND RESULTS: Electronic databases and bibliographies were systematically searched (1996-2014). Twelve studies (5009 patients) recruiting patients with coronary artery disease or non-ischaemic cardiomyopathy met our inclusion criteria. Fragmented QRS was associated with an all-cause mortality relative risk of 1.71 (CI 1.02-2.85) and a relative risk of SCD of 2.20 (CI 1.05-4.62). Subgroup analysis demonstrated greater mortality and SCD risk in those with left ventricular ejection fraction >35% and SCD risk in those with QRS duration <120 ms. CONCLUSION: Fragmented QRS is associated with all-cause mortality and the occurrence of SCD and may be suited as a marker of SCD risk. The incremental benefit of fQRS should be assessed in a randomized, prospective setting.
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Rosengarten et al. (2014) conducted a meta-analysis in coronary artery disease or non-ischaemic cardiomyopathy (n=5,009). Fragmented QRS (fQRS) was evaluated on sudden cardiac death (SCD) (RR 2.20, 95% CI 1.05-4.62). Fragmented QRS was associated with an increased risk of sudden cardiac death (RR 2.20; 95% CI 1.05-4.62) and all-cause mortality (RR 1.71; 95% CI 1.02-2.85).
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