Author + information
- Zülkif Tanrıverdi1,
- Mustafa Aytek Şimşek2,
- Barış Ünal1,
- Hüseyin Dursun1,
- Ömer Kozan1 and
- Dayimi Kaya1
Fragmented QRS (fQRS) on surface ECG of patients admitted with acute ST elevated myocardial infarction (STEMI) is shown to be related with poor prognosis in several studies. However there is no study so far evaluated the relationship between presence of fQRS and successful reperfusion with thrombolytic therapy in this group of patients. The aim of our study is to determine whether fQRS can be used as a predictor of thrombolytic therapy response in patients admitting for the first time with STEMI.
116 patients admitted Dokuz Eylul University Hospital Cardiology Department for the first time with STEMI and treated with thrombolytic therapy between 01 january 2009 and 01 july 2011 are included in our study. Patients having ECG findings that can be misdiagnosed as fQRS [ incomplete right bundle branch block pattern in V1, pacemaker rhythm, wide QRS complex (QRS >120 ms)] and with CABG history are excluded. ECG recordings on admission, at the beginning, 30th, 60th, 90th minutes of thrombolytic therapy and in 48 hours of admission are obtained. Presence of fQRS is defined as presence of more than one R wave pattern or notching on R or S waves in neighbouring 2 derivations (Figure 1). Successful reperfusion is defined as over 50% resolution in the highest ST segment elevated derivation on the ECG taken in 90th minute of reperfusion therapy.
fQRS was present in 38.8% of patients (45 patients) included in our study. For patients with and without fQRS, there was no significant difference in myocardial infarction (MI) localization (anterior MI: 40% vs 35.2%, p>0.05) and mean door to needle time (29.1±9.4 vs. 26.9±8.1, p>0.05). But there was 28.4 % (27/95) fQRS in patients with successful reperfusion with thrombolytic therapy compared to 85.7% (18/21) in patients with failed reperfusion with thrombolytic therapy (p<0.001) (Figure 2). In addition to these findings patientys with fQRS compared to ones without it are older (66±12 vs 61±10, p=0.02), have more prolonged QRS durations (108.44±9.16 ms vs. 102.25±9.63 ms, p=0.001), have higher leukocyte counts (12.620±3.315 vs. 10.596 ±2.887, p=0.001), have lower left ventricle ejection fraction ((35.56±6.84% vs 47.96±5.64%, p<0.001) and have higher maximum troponin levels (60.60±29.62 vs 30.91±14.80, p<0.01) (Table 1).
Presence of fQRS in acute STEMI is not related with MI localization and timing of thrombolytic therapy. However fQRS on surface ECG of patients admitted with acute STEMI can predict the failure of thrombolytic therapy. Also presence of fQRS can help to determine high risk patients with broader myocardial tissue under threat.