Tanriverdi Zulkif, Dursun Huseyin, Colluoglu Tugce, Kaya Dayimi
Balikligol State Hospital - Clinic of Cardiology, Turkey.
Dokuz Eylul University - Faculty of Medicine - Department of Cardiology, Turkey.
Arq Bras Cardiol. 2017 Sep;109(3):213-221. doi: 10.5935/abc.20170099. Epub 2017 Jul 20.
QRS fragmentation (fQRS) is classically defined as the presence of slurred QRS morphology in at least two contiguous leads, and its prognostic importance has been shown in ST elevation myocardial infarction (STEMI). However, no study has investigated the significance of single lead fQRS (sl-fQRS) in surface electrocardiography (ECG).
To evaluate whether sl-fQRS is as valuable as classical fQRS in patients with acute STEMI who had successful revascularization with primary percutaneous coronary intervention (pPCI).
We included 330 patients with a first STEMI who had been successfully revascularized with pPCI. The patient's electrocardiography was obtained in the first 48 hours, and the patients were divided into three groups according to the absence of fQRS (no-fQRS); fQRS presence in a single lead (sl-fQRS); and ≥2 leads with fQRS (classical fQRS).
In-hospital mortality was significantly higher both in patients with sl-fQRS and in patients with ≥ 2 leads with fQRS compared to patients with no-fQRS. In ROC curve analysis, ≥ 1 leads with fQRS yielded a sensitivity of 75% and specificity of 57.4% for the prediction of in-hospital mortality. Multivariate analysis showed that sl-fQRS is an independent predictor of in-hospital mortality (OR: 3.989, 95% CI: 1.237-12.869, p = 0.021).
Although the concept of at least two derivations is mentioned for the classical definition of fQRS, our study showed that fQRS in only one lead is also associated with poor outcomes. Therefore, ≥1 leads with fQRS can be useful when describing the patients under high cardiac risk in acute STEMI.
QRS波碎裂（fQRS）传统上定义为至少两个相邻导联出现顿挫的QRS波形态，其预后意义已在ST段抬高型心肌梗死（STEMI）中得到证实。然而，尚无研究探讨单导联fQRS（sl-fQRS）在体表心电图（ECG）中的意义。
评估在接受直接经皮冠状动脉介入治疗（pPCI）实现血管再通的急性STEMI患者中，sl-fQRS是否与传统fQRS具有同样的价值。
我们纳入了330例首次发生STEMI且通过pPCI成功实现血管再通的患者。在发病后48小时内记录患者的心电图，并根据是否存在fQRS将患者分为三组：无fQRS（no-fQRS）组；单导联出现fQRS（sl-fQRS）组；≥2个导联出现fQRS（传统fQRS）组。
与no-fQRS组患者相比，sl-fQRS组和≥2个导联出现fQRS组患者的院内死亡率均显著更高。在ROC曲线分析中，≥1个导联出现fQRS对院内死亡率预测的敏感性为75%，特异性为57.4%。多因素分析显示，sl-fQRS是院内死亡率的独立预测因素（OR：3.989，95%CI：1.237-12.869，p = 0.021）。
尽管传统fQRS定义中提及至少两个导联，但我们的研究表明，仅一个导联出现fQRS也与不良预后相关。因此，在描述急性STEMI中高心脏风险患者时，≥1个导联出现fQRS可能有用。
