Short term prognostic significance of fragmented QRS in acute coronary syndrome

摘要

Background: Fragmented QRS (fQRS) is a simple parameter thatcan be obtained by standard 12 lead ECG. Recently this ECGparameter is being evaluated as a prognostic marker in different subset of patients. In recent years, fQRS is being evaluated as aprognostic marker in different patient population, not only incoronary artery disease, but also in Brugada syndrome, long QTsyndrome, Arrhythmogenic right ventricular dysplasia and cardiacsarcoidosis. Determination of prognosis is an important issuein management of acute coronary syndrome patients. So weplanned to evaluate the significance of fQRS in standard surfaceECG for determining prognosis.Methods: This study was done among admitted patients withacute coronary syndrome in IPGMER, Kolkata, from November2012 to May 2014.INCLUSSION CRITERIA-Patients presented firsttime with acute coronary syndrome, above 18 years of age, bothmale and female. EXCLUSION CRITERIA-1.Associated major othercomorbidies like malignancy, severe liver disease, end stage renalfailure, cerebrovascular accident, sepsis etc guarding the prognosis.2.Patients who are unable to follow-up.3.Patients with previoushistory of acute coronary syndrome. Every patient wasfollowed up for a period of 6 months.Results: A total number of 256 patients (Male:Female ? 163:45)were included. As 48 patients were lost to follow up, 208 subjectswere analyzed. Among them total 102 patients (Male:Female ?78:24) had fQRS in their ECG. Multivariate analysis showed thatpresence of fQRS predicts mortality (HR- 1.62, 95% C.I.-1.89-2.38,P<0.01) independently. Moreover, cardiac events also occurredsignificantly higher in patients with fQRS (HR- 7.16, 95% C.I.-3.17-20, P<0.01).Conclusion: fQRS is an independent predictor of mortality andadverse cardiac events in ACS patients.