Key result
The presence of fragmented QRS complexes before primary PCI independently predicted imperfect ST-segment resolution in patients with STEMI (OR 2.908; 95% CI 1.095-7.723; P=0.032).
Why the study?
Does the presence of fragmented QRS complexes predict imperfect ST-segment resolution in STEMI patients undergoing primary PCI?
Cohort (n=227)
Does the presence of fragmented QRS complexes predict imperfect ST-segment resolution in STEMI patients undergoing primary PCI?
Odds Ratio: 2.908 (95% CI 1.095–7.723)
p-value: p=0.032
The presence of fragmented QRS complexes on ECG before primary PCI is an independent predictor of imperfect ST-segment resolution and is associated with more severe coronary lesions and left ventricular dysfunction in STEMI patients.
Should not yet change STEMI management; hypothesis-generating for ECG-based risk stratification pending prospective validation.
OBJECTIVES: To investigate the clinical characteristics of patients with the fragmented QRS complexes (fQRS) and the predictive value of fQRS in patients undergoing primary percutaneous coronary intervention (p-PCI). METHODS: The study enrolled 227 consecutive patients with ST-elevation myocardial infarction who underwent p-PCI. Baseline clinical characteristics, the percentage of ST-segment resolution, and parameters of electrocardiography and coronary angiography were investigated. The relationship between fQRS on pre-PCI and post-PCI electrocardiogram and the percentage of ST-segment resolution after PCI were studied. RESULTS: Patients with fQRS have higher troponin I, creatine kinase-MB levels, prolonged QRS duration, higher Gensini score, lower percentage of total ST-segment resolution, and left ventricular ejection fraction compared with patients without fQRS. Gensini score (odds ratio [OR], 1.013; 95% confidence interval [CI], 1.002-1.024; P < .006) and percentage of total ST-segment resolution (OR, 0.384; 95% CI, 0.186-0.795; P = .01) were independently associated with the presence of fQRS. A multivariate logistic regression analysis selected presence of fQRS pre-PCI (OR, 2.908; 95% CI, 1.095-7.723; P = .032) and the number of leads with fQRS before PCI (OR, 1.582; 95% CI, 1.250-2.002; P < .001) as independent predictors of imperfect ST-segment resolution. CONCLUSIONS: The presence of fQRS is a predictor in ST-elevation myocardial infarction patients undergoing p-PCI. The occurrence of fQRS is beneficial to identify the patients with severe coronary lesion, left ventricular contraction dysfunction, and larger areas of ischemic injury.
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Ma et al. (2015) conducted a cohort in ST-elevation myocardial infarction (n=227). Fragmented QRS complexes (fQRS) vs. Patients without fQRS was evaluated on Imperfect ST-segment resolution (OR 2.908, 95% CI 1.095-7.723, p=0.032). The presence of fragmented QRS complexes before primary PCI independently predicted imperfect ST-segment resolution in patients with STEMI (OR 2.908; 95% CI 1.095-7.723; P=0.032).
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