Key result
QRS fragmentation in patients with acute STEMI was significantly associated with worse ST segment resolution, lower TIMI and MBG scores, lower ejection fraction, and higher complication rates.
Why the study?
Fragmented QRS is linked to adverse cardiovascular events, ventricular dysfunction, and poor prognosis in STEMI, but its relationship with myocardial reperfusion after fibrinolytic therapy or primary PCI remains to be evaluated.
Does the presence of QRS fragmentation predict the degree of myocardial reperfusion in patients with STEMI treated with reperfusion therapy?
RCT (n=100)
Randomized according to presence or absence of QRS fragmentation
Does the presence of QRS fragmentation predict the degree of myocardial reperfusion in patients with STEMI treated with reperfusion therapy?
The presence of QRS fragmentation on ECG is a reliable non-invasive predictor of poorer coronary reperfusion and worse clinical parameters in patients with acute STEMI.
May identify STEMI patients with impaired reperfusion; hypothesis-generating and requires prospective validation before guiding care.
Background: The main target of treatment of STEMI is to restore coronary blood flow and maintain myocardial perfusion. Several tools including electrocardiographic and coronary angiographic parameters are used to assess myocardial reperfusion. Fragmented QRS is associated with increased adverse cardiovascular events, it was proved to bea marker of ventricular dysfunction and poor prognosis in STEMI. Aim of the work : To study the relation between QRS fragmentations and the degree of myocardial reperfusion in patients with STEMI treated with either fibrinolytic therapy or primary percutaneous coronary interventions (1ry PCI). Patients and methods: 100 subjects admitted with first attack of STEMI were included. Twelve leads ECGs were evaluated for QRS morphology, patients were randomized in two groups according to presence or absence of QRS fragmentation, F-QRS group included 35 patients and NF-QRS group included 65 patients. The following parameters were used to assess the success of coronary reperfusion; ST segment resolution, TIMI score, MBG score and cardiac enzymes resolution. Results: ST segment resolution score was significantly higher among NF-QRS t. NFQRS group had better MBG and TIMI scores compared to patients with F-QRS group. F-QRS was significantly associated with lower EF and higher Klipp score. CKmb was significantly higher among F-QRS group. Complications were significantly higher among patients with F-QRS. Conclusion: QRS fragmentation can be a reliable predictor of coronary reperfusion in patients with acute STEMI treated with primary PCI or thrombolytic therapy.
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Sobh et al. (2023) conducted an RCT in Acute ST-segment elevation myocardial infarction (STEMI) (n=100). QRS fragmentation (F-QRS) vs. Absence of QRS fragmentation (NF-QRS) was evaluated on Success of coronary reperfusion (ST segment resolution, TIMI score, MBG score, and cardiac enzymes resolution). QRS fragmentation in patients with acute STEMI was significantly associated with worse ST segment resolution, lower TIMI and MBG scores, lower ejection fraction, and higher complication rates.
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