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[Association between fragmented QRS complexes and imperfect ST-segment resolution in patients with ST-elevation
Wenting Duan1, Xianghong Ma1, Lijun Cui1
1Department of Cardiology, Second Hospital of Tianjin Medical University, Tianjin 300211, China.
Insights
Fragmented QRS complexes (fQRS) on ECG are linked to poorer ST-segment resolution after primary percutaneous coronary intervention (p-PCI) in ST-elevation myocardial infarction (STEMI) patients. This finding suggests fQRS may indicate more severe coronary lesions and myocardial damage.
Area of Science:
- Cardiology
- Electrophysiology
Context:
- ST-elevation myocardial infarction (STEMI) is a critical condition requiring timely reperfusion.
- Primary percutaneous coronary intervention (p-PCI) is the preferred treatment for STEMI.
- Assessing myocardial reperfusion and infarct size is crucial for patient outcomes.
Purpose:
- To investigate the association between fragmented QRS complexes (fQRS) and inadequate ST-segment resolution following p-PCI in STEMI patients.
- To determine if fQRS can predict adverse cardiac events or indicators of myocardial damage.
Summary:
- A study of 227 STEMI patients undergoing p-PCI found that the presence of fQRS on electrocardiograms (ECG) correlated with higher cardiac enzyme levels (cTnI, CK, CK-MB), elevated Gensini scores, prolonged QRS intervals, and reduced left ventricular ejection fraction (LVEF).
- Patients with fQRS exhibited a significantly lower rate of ST-segment resolution post-p-PCI.
- Multivariate analysis identified fQRS presence, the number of leads with fQRS, and increased QRS interval as independent predictors of imperfect ST-segment resolution.
Impact:
- Fragmented QRS complexes (fQRS) may serve as a valuable non-invasive biomarker to identify STEMI patients at higher risk of poor reperfusion and adverse cardiac outcomes.
- fQRS could aid clinicians in stratifying patients, potentially guiding treatment intensity and follow-up strategies.
- This research highlights the prognostic significance of ECG findings in the acute phase of myocardial infarction.
Objective:
To explore the relationship between fragmented QRS complexes (fQRS) and imperfect ST-segment resolution in ST elevation myocardial infarction (STEMI) patients undergoing primary percutaneous coronary intervention (p-PCI).
Methods:
This study included 227 consecutive patients with STEMI who underwent p-PCI. They were divided into two groups: ECG with fQRS (n = 142) and without fQRS (n = 85). Baseline clinical characteristics,Gensini score, coronary angiography features and the rate of ST-segment resolution were compared between the two groups.
Results:
(1) Patients with fQRS of ECG had higher cTnI, CK, CK-MB levels and Gensini score, prolonged QRS interval, lower rate of ST-segment resolution and left ventricular ejection fraction (LVEF) than in patients without fQRS (all P < 0.01 or P < 0.05). (2) Pearson correlation analysis showed that the rate of ST-segment resolution (r = -0.207, P = 0.002),Gensini score (r = 0.191, P = 0.004), LVEF(r = -0.188, P = 0.006), cTnI(r = 0.172, P = 0.010), and the TIMI grade post p-PCI (r = -0.148, P = 0.028) were significantly related with the presence of fQRS. (3) Multivariate logistic regression analysis demonstrated that presence of fQRS at pre-PCI (OR = 2.908, 95%CI:1.095-7.723, P = 0.032) , the number of leads with fQRS before PCI (OR = 1.582, 95%CI:1.250-2.002, P < 0.001), and increased QRS interval (OR = 0.955, 95%CI: 0.924-0.988, P = 0.008) were independent predictors of imperfect ST-segment resolution.
Conclusions:
fQRS is related to imperfect ST-segment resolution in STEMI patients undergoing p-PCI.fQRS may be a useful parameter to identify the patients with severe coronary lesion, larger areas of ischemic injury and myocardial infarction as well as severe left ventricular contracted dysfunction.
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