Prognostic value of fragmented QRS on a 12-lead ECG in patients with acute myocardial infarction
| Autor: | Luc Lorgis, Charles Guenancia, Gilles Dentan, Laurent Mock, Marianne Zeller, Olivier Hachet, Yves Cottin, François Jourda, Aurélie Gudjoncik, Karim Stamboul |
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| Rok vydání: | 2013 |
| Předmět: |
Male
Pulmonary and Respiratory Medicine medicine.medical_specialty Myocardial Infarction Critical Care and Intensive Care Medicine Coronary artery disease Electrocardiography Recurrence Internal medicine medicine Humans Prospective Studies cardiovascular diseases Myocardial infarction Prospective cohort study Aged Heart Failure Univariate analysis Ejection fraction Proportional hazards model business.industry Arrhythmias Cardiac Middle Aged Prognosis medicine.disease Survival Analysis Logistic Models Heart failure Cardiology Female Cardiology and Cardiovascular Medicine business Mace |
| Zdroj: | Heart & Lung. 42:326-331 |
| ISSN: | 0147-9563 |
| Popis: | Objective To investigate the determinants and the prognostic value of fragmented QRS (fQRS) after AMI. Patients and methods Prospective cohort of 307 consecutive patients with AMI. Main outcomes measured MACE (death plus non-fatal recurrent MI), hospitalization for an episode of heart failure, ventricular arrhythmia (VT or VF) at two years follow-up. Results On the serial 12-lead ECG recorded during the in-hospital stay, 162 (53%) had no fQRS ( no fQRS group ). 145 (47%) presented an fQRS, which was persistent in 108 (34%) patients ( persistent fQRS group ) and transient in 37 (12%) patients ( transient fQRS group ). Patients with a fragmented QRS (transient or persistent) were older, more likely to be hypertensive and less likely to be smokers than were patients without fQRS. By multivariate logistic regression analysis, only hypertension (OR (95% CI): 1.66 (1.00–2.74); p = 0.047) was associated with an fQRS. During a mean follow-up of 846 ± 297 days, there were 82 MACE recorded: 17 patients died from a CV cause (10% event rate) among patients without fQRS, 22 (20% event rate) among patients with persistent fQRS and 3 (8% event rate) among patients with transient fQRS. Similarly, non-fatal recurrent MI occurred more frequently in patients with fQRS (18 (16%) and 10 (27%)) for persistent and transient fQRS, respectively, vs. 16 (10%) in the no fQRS group ( p = 0.019). However, the occurrence of heart failure symptoms and ventricular arrhythmia was not significantly different ( p = 0.162 and p = 0.242, respectively). Survival analysis by the Kaplan–Meier method showed a significant difference (log rank p = 0.026) between groups, and only persistent fQRS was associated with decreased survival. In multivariate cox regression analysis, the GRACE score, blood glucose on admission, and B-blockers in the acute phase were independent predictors of MACE at two years. fQRS was not a significant independent predictor of MACE (HR (95% CI): 1.57 (0.95–2.60); p = 0.08). Moreover, fQRS was not a predictor of heart failure or ventricular arrhythmia in univariate analysis. Conclusions Persistent fQRS on a 12-lead ECG is a marker of decreased survival after AMI, whereas transient fQRS correlates with recurrent MI. |
| Databáze: | OpenAIRE |
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