Fragmented QRS complex as a predictor of no-reflow in myocardial infarction: a systematic review and meta-analysis

Coronary no-reflow is associated with adverse outcomes in patients with myocardial infarction (MI). This study aimed to evaluate the association between the presence of fragmented QRS (fQRS) and no-reflow in MI patients.

A systematic search was conducted across four databases from inception to July 20, 2024. The inclusion criteria were studies that enrolled MI patients, stratified by the presence of fQRS, and reported at least one of the following outcomes: no-reflow, infarct size, reinfarction, or repeat revascularization during hospitalization. No-reflow was defined as a Thrombolysis In Myocardial Infarction (TIMI) flow grade < 3.

A total of 19 studies with 5840 participants were analyzed using a random-effects model. The presence of fQRS was associated with a higher risk of no-reflow compared to non-fQRS in MI patients, with an odds ratio (OR) of 2.08 (95% CI 1.39 to 3.12), P < 0.01. Subgroup analysis by study design supported this finding. However, there were no significant differences in infarct size, in-hospital reinfarction, or need for repeat revascularization between groups.

The presence of fQRS was associated with a higher risk of no-reflow in MI patients. fQRS could serve as a useful tool for predicting no-reflow and guiding primary prevention strategies in MI patients.