Cardiovascular Research Center of Tabriz University of Medical Sciences.
Int J Gen Med. 2013 May 28;6:399-404. doi: 10.2147/IJGM.S40050. Print 2013.
Fragmented QRS encompasses different RSR' patterns showing various morphologies of the QRS complexes with or without the Q wave on a resting 12-lead electrocardiogram. It has been shown possibly to cause adverse cardiac outcomes in patients with some heart diseases, including coronary artery disease. In view of the need for risk stratification of patients presenting with acute coronary syndrome in the most efficacious and cost-effective way, we conducted this study to clarify the value of developing fragmented QRS in a cohort of patients presenting with their first acute coronary syndrome in predicting 6-month mortality and morbidity.
One hundred consecutive patients admitted to the coronary care unit at Shahid Madani Heart Center in Tabriz from December 2008 to March 2009 with their first acute coronary syndrome were enrolled in this prospective study. Demographic and electrocardiographic data on admission, inhospital mortality, and need for revascularization were recorded. Electrocardiography performed 2 months after the index event was examined for development of fragmented QRS. Mortality and morbidity was evaluated at 6-month follow-up in all patients.
The patients were of mean age 57.7 ± 12.8 years, and 84% were men. The primary diagnosis was unstable angina in 17 (17%) patients, non-ST elevation myocardial infarction (MI) in 11 (11%), anterior or inferior ST elevation MI in 66 (66%), and postero-inferior MI in six (6%). Fragmented QRS was present in 30 (30%) patients during the first admission, which increased to 44% at the 2-month follow-up and to 53% at the 6-month follow-up. The presence of various coronary risk factors and drug therapy given, including fibrinolytic agents, had no effect on development of fragmented QRS. Mortality was significantly higher (P = 0.032) and left ventricular ejection fraction was significantly lower (P = 0.001) in the fragmented QRS group at the 6-month follow-up.
This study strongly suggests that fragmented QRS on initial presentation with acute coronary syndrome is not predictive of subsequent events but, if present 6 months later, could be predictive of an adverse outcome.
碎裂 QRS 包括不同的 RSR' 模式，在静息 12 导联心电图上显示出各种 QRS 复合体形态，有或无 Q 波。已经表明，它可能导致某些心脏病患者（包括冠心病）出现不良心脏结局。鉴于需要以最有效和最具成本效益的方式对急性冠状动脉综合征患者进行风险分层，我们进行了这项研究，以阐明在首次出现急性冠状动脉综合征的患者中，碎裂 QRS 的出现对预测 6 个月死亡率和发病率的价值。
本前瞻性研究纳入了 2008 年 12 月至 2009 年 3 月在大不里士沙希德·马丹尼心脏中心因首次急性冠状动脉综合征入住冠心病监护病房的 100 例连续患者。记录入院时的人口统计学和心电图数据、住院死亡率和血运重建需求。在指数事件后 2 个月进行心电图检查，以检查是否出现碎裂 QRS。所有患者在 6 个月时进行死亡率和发病率评估。
患者的平均年龄为 57.7 ± 12.8 岁，84%为男性。主要诊断为不稳定型心绞痛 17 例（17%）、非 ST 段抬高型心肌梗死 11 例（11%）、前壁或下壁 ST 段抬高型心肌梗死 66 例（66%）、下后壁心肌梗死 6 例（6%）。30 例（30%）患者在首次入院时存在碎裂 QRS，2 个月随访时增加至 44%，6 个月随访时增加至 53%。各种冠状动脉危险因素的存在和给予的药物治疗（包括纤溶药物）对碎裂 QRS 的发展没有影响。在 6 个月随访时，碎裂 QRS 组的死亡率显著升高（P = 0.032），左心室射血分数显著降低（P = 0.001）。
本研究强烈表明，急性冠状动脉综合征首发时出现碎裂 QRS 并不能预测后续事件，但如果 6 个月后出现，则可能预示着不良结局。
