The Role of Fragmented QRS (fQRS) As A Predictor of Major Adverse Cardiac Event within 30 days in Acute Coronary Syndrome Patients: A Retrospective Cohort Study

Anastasia Asylia Dinakrisma, Ika Prasetya Wijaya, Sally Aman Nasution, Esthika Dewiasty

Abstract


Background: some studies show fragmanted QRS (fQRS) as a marker of myocardial scar, ventricular arrhythmia, ventricular remodelling and worse coronary collaterals flow, which can increase the incidence of major adverse cardiac event (MACE) after infarction. This study aimed to identify the role of fQRS as one of the risk factors for MACE (cardiac death and reinfarction) in acute coronary syndrome patients within 30 days observation. Methods: a cohort retrospective study was conducted using secondary data of acute coronary syndrome patients at Intensive Cardiac Care Unit Cipto Mangunkusumo Hospital from July 2015 to October 2017. Multivariate analysis were done by using logistic regression with GRACE score (moderate and high risk), low eGFR (< 60 ml/min), low LVEF (< 40%), diabetes mellitus, age more than 45 years and hypertension as confounding factors. Results: three hundred and fifty three (353) subjects were included. Fragmented QRS was found in 60,9 % subjects. It was more frequent in inferior leads (48.8% ) with mean onset of 34 hours. Major adverse cardiac events were higher in fQRS vs. non-fQRS group (15.8% vs. 5.8 %). Bivariate analysis showed higher probability of 30 days MACE in fQRS group (RR 2.72; 95%CI 1.3 -5.71p=0.08). Multivariate analysis revealed adjusted RR of 2.79 (95% CI: 1.29 – 4.43, p<0.05). Low eGFR was a potential confounder in this study. Conclusion: persistent fQRS developed in ACS during hospitalization is an independent predictor of 30 days MACE cardiac death and re-infarction.


Keywords


acute coronary syndrome; fQRS; Major adverse cardiac event

References


Gaziano TA, Prabhakaran D, Gaziano M. Global burden of cardiovascular disease. 10th ed. In: Mann D. Zipes D. Libbby P. Bonow R. Braunwald E, eds. Phildapelphia: Elsevier Saunders; 2015. p. 1-10.

Chan MY, Du X, Eccleston D, et al. Acute coronary syndrome in the Asia-Pacific region. Int J Cardiol. 2016;202:861–9.

Armen, Prasetya I. Validasi skor global registry of acute coronary event (GRACE) dalam memprediksi mortalitas selama perawatan pada pasien sindrom koroner akut di ICCU Rumah Sakit Cipto Mangunkusumo. Tesis. Universitas Indonesia. 2012.

Badan Penelitian Dan Pengembangan Kesehatan Kementerian Kesehatan RI. Riset kesehatan dasar. Minist Heal Repub Indones. 2013;(1):1–303.

Dewiasty E. Alwi I. Estimasi laju filtrasi glomerulus sebagai prediktor mortalitas pada pasien sindrom koroner akut selama perawatan di ICCU RSCM. Tesis.Universitas Indonesia: 2008.

Das MK, Suradi H, Maskoun W, et al. Fragmented wide QRS on a 12-lead ECG: a sign of myocardial scar and poor prognosis. Circ Arrhythm Electrophysiol. 2008;1(4):258–68.

Sheng Q-H, Hsu C, Li J, Hong T, Huo Y. Correlation between fragmented QRS and the short-term prognosis of patients with acute myocardial infarction. J Zhejiang Univ Sci B. 2014;15(1):67–74.

Kadı H, Ceyhan K, Koç F, Celik A, Onalan O. Relation between fragmented QRS and collateral circulation in patients with chronic total occlusion without prior myocardial infarction. Anadolu Kardiyol Derg. 2011;11(4):300–4.

Güngör B, Özcan KS, Karataş MB, et al. Prognostic value of QRS fragmentation in patients with acute myocardial infarction: A Meta-Analysis. Ann Noninvasive Electrocardiol. 2016;21(6):604–12.

Yudhatama D, Makmun L, Antono D. Peranan fragmented QRS sebagai prediktor aritmia ventrikel pada pasien infark miokardium akut. Universitas Indonesia. Tesis: 2011.

Rhee J, Sabatine M, Llily L. Acute coronary syndromes. In: Lili L, editor. Pathophysiology of heart disease: a collaborative project of medical student and faculty. 5th ed. Philadelphia: Lippincot Williams & Wilkins; 2011. p. 161–89.

Seghieri C. Mimmi S. Lenzi J. Fantini MP. 30-day in-hospital mortality after acute myocardial infarction in Tuscany (Italy): An observational study using hospital discharge data. BMC Med Res Methodol. 2012;12(1):170.

Wang DD, Buerkel DM, Corbett JR. Fragmented QRS complex has poor sensitivity in detecting myocardial scar. Ann Non-invasive. Electrocardiol. 2010;15:308–14.

Lorgis L, Jourda F, Hachet O, et al. Prognostic value of fragmented QRS on a 12-lead ECG in patients with acute myocardial infarction. Heart Lung. 2013;42(5):326–31.

Medagama A, Bandara R, Silva C, De Galgomuwa MP. Management of acute coronary syndromes in a developing country ; time for a paradigm shift ? an observational study. BMC Cardiovasc Disord. 2015;1–8.

Thygesen K, Alpert JS, Jaffe AS, et al. Third universal definition of myocardial infarction. Eur Heart J. 2012;33(20):2551–67.

Kadi H, Kevser A, Ozturk A, Koc F, Ceyhan K. Fragmented QRS complexes are associated with increased left ventricular mass in patients with essential hypertension. Ann Noninvasive Electrocardiol. 2013;18(6):547–54.

Bhukkar M, Makmun L, Widodo D. Late potential sebagai prediktor aritmia pasca infark miokard akut dengan menggunakan signal averaged ECG. Tesis. Universitas Indonesia: 2005.

Smith SC, Benjamin EJ, Bonow RO, et al. AHA/ACCF secondary prevention and risk reduction therapy for patients with coronary and other atherosclerotic vascular disease: 2011 update: A guideline from the American Heart Association and American College of Cardiology Foundation. Circulation. 2011;124(22):2458–73.


Full Text: PDF

Refbacks

  • There are currently no refbacks.


Copyright (c) 2019 Acta Medica Indonesiana