Risk Factors for QRS-Fragmentation in Patients with STEMI Undergoing PCI
Florian Tinhofer1,2,3, Rosana Rakhimova4, Elena A Badykova4
13rd Medical Department with Cardiology and Intensive Care Medicine, Clinic Ottakring, 1160 Vienna, Austria.
Insights
Fragmentation of the QRS complex (fQRS) in ST-elevation myocardial infarction (STEMI) patients undergoing PCI is linked to elevated C-reactive protein (CRP) levels. This suggests fQRS may indicate significant inflammation during myocardial ischemia.
Area of Science:
- Cardiology
- Biomedical Engineering
- Clinical Research
Background:
- ST-elevation myocardial infarction (STEMI) remains a leading cause of cardiovascular mortality globally.
- Early risk stratification is vital for effective STEMI management, particularly in resource-limited settings.
- QRS fragmentation (fQRS) is an emerging electrocardiographic marker with prognostic implications in STEMI.
Purpose of the Study:
- To investigate the underlying mechanisms and risk factors associated with fQRS occurrence in STEMI patients undergoing primary percutaneous coronary intervention (pPCI).
- To analyze the correlation between fQRS and various clinical and biochemical parameters in STEMI patients post-pPCI.
Main Methods:
- A cohort of 122 STEMI patients undergoing pPCI between September 2020 and June 2021 were analyzed.
- fQRS occurrence was assessed and correlated with clinical data and biochemical markers, including C-reactive protein (CRP) and glomerular filtration rate (GFR).
- Univariable and multivariable logistic regression models were employed to identify independent predictors of fQRS.
Main Results:
- The fQRS pattern was observed in 33.6% of the studied STEMI patients.
- Univariable analysis revealed significant associations between fQRS and both GFR (p=0.050) and CRP levels (p=0.014).
- Multivariable analysis confirmed that only elevated CRP levels on admission were independently associated with the presence of fQRS (OR=3.44, p=0.029).
Conclusions:
- A significant correlation exists between fQRS and CRP levels in STEMI patients treated with pPCI.
- fQRS may serve as a valuable indicator of extensive inflammation in the context of myocardial ischemia.
- Further research could explore fQRS's role in risk stratification and guiding therapeutic interventions in STEMI.
Abstract:
Background and Objectives: Despite modern therapy algorithms, ST-elevation myocardial infarction (STEMI) substantially contributes to cardiovascular morbidity and mortality worldwide. Early Risk assessment is crucial to guide therapy allocation, especially in countries with limited healthcare resources. Electrocardiographic parameters such as QRS fragmentation (fQRS) evolved as an important prognostic marker. The underlying mechanisms and specific risk factors for the occurrence of fQRS in patients with STEMI undergoing PCI have not been analyzed yet. Materials and Methods: Between 09/2020 and 06/2021, out of 179 consecutive patients with STEMI undergoing primary percutaneous coronary intervention (pPCI), 122 patients were included in this study. The occurrence of fQRS was analyzed and correlated to clinical as well as biochemical parameters. Results: In this population, the fQRS pattern was present in 33.6% (n = 41) of patients. Besides gender, no statistically significant differences in baseline characteristics or comorbidities were observed between the two groups. In univariable logistic regression analysis, both glomerular filtration rate (GFR) (p = 0.050) and C-reactive protein (CRP) (p = 0.014) were significantly associated with the presence of fQRS. However, in the multivariable logistic regression model, only CRP levels on admission remained independently associated with fQRS (OR = 3.44, 95% CI: 1.95; 6.05), (p = 0.029). Conclusions: In this analysis, a correlation between fQRS and CRP levels in patients with STEMI undergoing pPCI could be demonstrated. Consequently, fQRS might serve as a marker for extensive inflammation in the context of myocardial ischemia.
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