The predictive value of fragmented QRS complex for in-hospital and long-term cardiovascular mortality in patients with ST segment elevation myocardial infarction undergoing emergency coronary artery bypass grafting
Derya Ozturk, Omer Celik, Mehmet Erturk, Serkan Aslan, Ali Kemal Kalkan, Ender Oner, Fatih Uzun, Onur Sen, Unal Aydin, Abdurrahman Eksik.
Abstract Objectives: The aim of the present study was to investigate the predictive value of fragmented QRS (fQRS) complex on admission electrocardiography (ECG) for in-hospital and long-term cardiovascular mortality in patients with STEMI undergoing emergency coronary artery bypass grafting(CABG).
Materials and Methods: In this retrospective study, 102 patients who were diagnosed with STEMI and underwent emergency CABG operation were included. The electrocardiographic recordings of the study patients were reviewed for the presence or absence of the fQRS complex on admission ECG.
Results: In-hospital cardiovascular mortality rate was 11.7%. The rate of fQRS complex was higher in the non-survivor group than the survivors (p=0.03). In the univariate analysis; left ventricular ejection fraction, troponin levels, creatinine levels, grade 3 ischemia, fQRS, and cardiogenic shock were found to be statistically significant for predicting mortality. However , serum creatinine (OR: 4.253 ; 95 %CI : 1.279 -14.140 ; p=0.01), left ventricular ejection fraction (OR:0.878 ; 95% CI:0.771 -1.001 ; p=0.05 ) and presence of cardiogenic shock (OR:4.552 ; 95 %CI : 1.126 -18.409 ; p=0.03) were found to be significant independent predictors of in-hospital cardiovascular mortality after adjustment of other risk factors in the multivariate analysis. When we assessed the association between fQRS and long-term mortality in the Kaplan–Meier survival analysis, the long-term survival of fQRS positive patients was significantly lower than those who were fQRS negative(p=0.04) .
Conclusions: The major predictors of in-hospital mortality in patients who underwent emergency CABG were creatinine levels, low ejection fraction and cardiogenic shock. The presence of fQRS was associated with long-term survival and it seems to be related with in-hospital mortality. However, it was not found to be an independent predictor of in-hospital mortality.