Value of QRS fragmentation as novel electrocardiogram predictor of reperfusion in acute myocardial infarction patient

Abstract

Background: The main target of treatment of ST elevation myocardial infarction (STEMI) is to restore coronary blood flow and maintain myocardial perfusion. Several tools including electrocardiographic and coronary angiographic parameters are used to assess myocardial reperfusion. Fragmented QRS is associated with increased adverse cardiovascular events, it was proved to bea marker of ventricular dysfunction and poor prognosis in STEMI. Aim: To study the relation between QRS fragmentations and the degree of myocardial reperfusion in patients with STEMI treated with either fibrinolytic therapy or primary percutaneous coronary interventions (1ry PCI). Patients and methods: 100 subjects admitted with first attack of STEMI were included. Twelve leads ECGs were evaluated for QRS morphology, patients were randomized in two groups according to presence or absence of QRS fragmentation, fragmented QRS (F-QRS) group included 35 patients and non fragmented QRS (NF-QRS) group included 65 patients. The following parameters were used to assess the success of coronary reperfusion; ST segment resolution, thrombolysis in myocardial Infarction coronary grade flow (TIMI score), myocardial blush grades (MBG) score and cardiac enzymes resolution. Results: ST segment resolution score was significantly higher among NF-QRS t. NFQRS group had better myocardial blush grades and TIMI scores compared with patients with F-QRS group. F-QRS was significantly associated with lower EF and higher Klipp score. CKmb was significantly higher among F-QRS group. Complications were significantly higher among patients with F-QRS. Conclusion: QRS fragmentation can be a reliable predictor of coronary reperfusion in patients with acute STEMI treated with primary percutaneous coronary interventions or thrombolytic therapy.