Significance of fragmented QRS complex in patients treated with thrombolytic therapy for acute ST elevation myocardial infarction and its relationship with myocardial perfusion

Background and Objectives: In acute STEMI cases inadequate myocardial reperfusion in after thrombolytic therapy is associated with increased mortality. In our study we aimed to evaluate the relationship between TIMI myocardial perfusion (TMP) grade as an indicator of myocardial reperfusion and fragmented QRS (fQRS) in standart 12-lead electrocardiogram and if it is possible or not to use fQRS as an additional indicator of myocardial reperfusion.Methods: From March 2004 to June 2006, 100 patients admitted with first STEMI to Gazi University Hospital Coronary Intensive Care Unit and Selçuk University Hospital Coronary Intensive Care Unit and who were administered thrombolytic therapy, were included in this retrospective study. Demographic parameters and routine laboratory parameters of patients are recorded. Standard 12-lead electrocardiogram records of patients simultaneous with coronary angiography ( second day) were assessed and analysed for presence of fQRS. Also coronary angiography images were analyzed to identify the infarct related artery, TIMI grade of infarct related artery, TMP grade of infarct related artery.Results: When analysed the basal characteristics most of the patients were smoking (%72). fQRS was present in 45 patients. According to presence or absence of fQRS patients divided into two grups and compared. The patients with fQRS demonstrated a significantly lower TIMI grade, TMP grade and ejection fraction measured by echocardiography compared with the non-fQRS patients (p=0.003, p=0.004, p=0.02 respectively).According to adequate myocardial reperfusion (TMP 3) or inadequate myocardial reperfusion (TMP 2/1/0) patients divided into two grups and groups were compared. Adequate myocardial reperfusion (TMP 3) was present in 34 patients; inadequate myocardial reperfusion (TMP 2/1/0) was present in 65 patients. (p=0.012, p=0.033 respectively). The patients with inadequate myocardial reperfusion demonstrated a significantly higher fQRS compared with the adequate myocardial reperfusion patients. (%56.9 versus %23.5, p=0.002 respectively).On correlation analysis, there was a significant negative correlation between fQRS and left ventricular ejection fraction (R=-232, p=0.02). TIMI grade and adequate TIMI flow (TIMI 3) showed significant negative correlation with fQRS (R=-0.347, p=0.000;R= -0.318, p=0.002 respectively). TMP grade and adequate myocardial reperfusion (TMP 3) showed significant negative correlation with fQRS (R=-0.370, p=0.000;R= -0.318, p=0.001 respectively).Results : Presence of fragmented QRS in STEMI patients was associated with inadequate myocardial reperfusion and it can be used as a simple, noninvasive parameter to evaluate myocardial reperfusion.Key Words: Acute STEMI, Fragmented QRS, Reperfusion.