Aims: To assess the association of prolonged QRS duration and late mortality in unselected post- infarction patients of the revascularization era. Methods and results: A total of 1455 survivors of acute myocardial infarction(MI) in sinus rhythm and under 76 years ofage were enrolled. Ninety eight percent of the patients received reperfusion/ revascularization therapy(90% percutaneous coronary intervention). After revascularization, prolonged QRS duration(≥ 120 ms) was present in 87 patients(6.0% ). Additional risk factors studied were age(≥ 65 years), presence of diabetes mellitus, history of previous MI, mean heart rate(>75 b.p.m.), heart rate variability index(≤ 20 U), arrhythmia on Holter, left ventricular ejection fraction(LVEF ≤ 30% ), and heart rate turbulence(HRT). Primary endpoint was total mortality. During a follow- up period of 22± 5 months, 70 patients died. On multivariable analysis, prolonged QRS duration showed the highest association with total mortality(hazard ratio 4.0; Cl 2.3- 6.9) followed by HRT Category 2(3.8; 2.0- 7.3) and LVEF≤ 30% (3.1; 1.7- 5.6). The association of prolonged QRS duration and late mortality was particularly strong in patients with LVEF ≤ 30% (5.0; 1.8- 14.1). On multivariable analysis of secondary endpoints, prolonged QRS duration was significantly associated with cardiac mortality(3.9; 1.9- 7.8), but not with sudden death and serious arrhythmic events. Conclusion: In the revascularization era, incidence of prolonged QRS duration is reduced. However, prolonged QRS duration is still highly correlated with increased late mortality.
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