Research Article
BibTex RIS Cite
Year 2024, Volume: 37 Issue: 2, 121 - 128, 31.05.2024
https://doi.org/10.5472/marumj.1485355

Abstract

References

  • Ibanez B, James S, Agewall S, et al.. ESC Scientific Document Group. 2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation: The Task Force for the management of acute myocardial infarction in patients presenting with ST-segment elevation of the European Society of Cardiology (ESC). Eur Heart J 2018 7;39:119-77. doi: 10.1093/eurheartj/ehx393.
  • Rohn V, Grus T, Belohlavek J, Horak J. Surgical revascularisation in the early phase of ST-segment elevation myocardial infarction: Haemodynamic status is more important than the timing of the operation. Heart Lung Circ 2017;26:1323-29. doi: 10.1016/j.hlc.2017.01.009.
  • Khan AN, Sabbagh S, Ittaman S, et al. Outcome of early revascularization surgery in patients with ST-elevation myocardial infarction. J Interv Cardiol 2015;28:14-23. doi: 10.1111/joic.12177.
  • Das MK, Saha C, El Masry H, et al. Fragmented QRS on a 12-lead ECG: a predictor of mortality and cardiac events in patients with coronary artery disease. Heart Rhythm 2007;4:1385-92. doi: 10.1016/j.hrthm.2007.06.024.
  • Gungor B, Ozcan K S, Karatas M B, Sahin I, Ozturk R, Bolca O. (2016). Prognostic value of QRS fragmentation in patients with acute myocardial infarction: a meta-analysis. Ann Noninvasive Electrocardiol 2016;21:604-12. doi:10.1111/ anec.12357
  • Rosengarten J A, Scott P A, Morgan J M. 2015). Fragmented QRS for the prediction of sudden cardiac death: a metaanalysis. Europace 2025; 17: 969-77. doi:10.1093/europace/ euu279
  • Altunova M, Püşüroğlu H, Karakayalı M, et al. Relationship between fragmented QES complex and longterm cardiovascular outcome in patients with essential hypertension. Anatol J Cardiol. 2022;26:442-9. doi: 10.5152/ AnatolJCardiol.2022.1322.
  • Kewcharoen J, Trongtorsak A, Kittipibul V, et al. Fragmented QRS predicts reperfusion failure and in-hospital mortality in ST-Elevation myocardial infarction: a systematic review and meta-analysis. Acta Cardiol 2020 ;75:298-311. doi: 10.1080/00015.385.2019.1584696.
  • Xia W, Feng XY. Fragmented QRS (fQRS) complex predicts adverse cardiac events of st-segment elevation myocardial infarction patients undergoing percutaneous coronary intervention and thrombolysis. Med Sci Monit 2018;24: 4634- 40. doi: 10.12659/MSM.908712.
  • Çiçek Y, Kocaman SA, Durakoğlugil M, et al. Relationship of fragmented QRS with prognostic markers and long-term major adverse cardiac events in patients undergoing coronary artery bypass graft surgery. J Cardiovasc Med (Hagerstown) 2015;16:112-7. doi: 10.2459/01.JCM.000.043.5615.40439.68.
  • Levy B, Clere-Jehl R, Legras A, et al. Epinephrine versus norepinephrine for cardiogenic shock after acute myocardial infarction. J Am Coll Cardiol 2018;72:173-82. doi:0.1016/j. jacc.2018.04.051.
  • Karakayali M, Artac I, Omar T, et al. The association between frontal QRS-T angle and reverse dipper status in newly diagnosed hypertensive patients. Blood Press Monit 2023;28:96-102. doi: 10.1097/MBP.000.000.0000000637.
  • Lang RM, Badano LP, Mor-Avi V, et al. Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. J Am Soc Echocardiogr 2015;28:1-39.
  • de Lemos JA, Morrow DA, Gibson CM, et al. TIMI 14 Investigators. Thrombosis in myocardial infarction. Early noninvasive detection of failed epicardial reperfusion after fibrinolytic therapy. Am J Cardiol 2001;88:353-8. doi: 10.1016/ s0002-9149(01)01678-2.
  • Das MK, Khan B, Jacob S, Mahenthiran J. Significance of a fragmented QRS complex versus a Q wave in patients with coronary artery disease. Circulation 2006;113:2495-501. doi: 10.1161/CIRCULATIONAHA.105.595892.
  • Gu YL, van der Horst IC, Douglas YL, Svilaas T, Mariani MA, Zijlstra F. Role of coronary artery bypass grafting during the acute and subacute phase of ST-elevation myocardial infarction. Neth Heart J 2010;18:348-54. doi: 10.1007/ BF03091790.
  • Lang Q, Qin C, Meng W. Appropriate timing of coronary artery bypass graft surgery for acute myocardial infarction patients: A meta-analysis. Front Cardiovasc Med 2022;9:794925. doi: 10.3389/fcvm.2022.794925.
  • Voisine P, Mathieu P, Doyle D, et al. Influence of time elapsed between myocardial infarction and coronary artery bypass grafting surgery on operative mortality. Eur J Cardiothorac Surg 2006;29:319-23. doi: 10.1016/j.ejcts.2005.12.021.
  • Axelsson TA, Mennander A, Malmberg M, Gunn J, Jeppsson A, Gudbjartsson T. Is emergency and salvage coronary artery bypass grafting justified? The Nordic Emergency/Salvage coronary artery bypass grafting study. Eur J Cardiothorac Surg 2016;49:1451-6. doi: 10.1093/ejcts/ezv388.
  • Uygur B, Demir AR, Guner A, Iyigun T, Uzun N, Celik O. Utility of logistic clinical SYNTAX score in prediction of inhospital mortality in ST-elevation myocardial infarction patients undergoing emergent coronary artery bypass graft surgery. J Card Surg 2021;36:857-63. doi: 10.1111/jocs.15308.
  • Lemaire A, Vagaonescu T, Ikegami H, Volk L, Verghis N, Lee LY. Delay in coronary artery bypass grafting for STEMI patients improves hospital morbidity and mortality. J Cardiothorac Surg 2020;15:86. doi: 10.1186/s13019.020.01134-x.
  • Ranucci M, Castelvecchio S, Menicanti L, Frigiola A, Pelissero G. Risk of assessing mortality risk in elective cardiac operations: age, creatinine, ejection fraction, and the law of parsimony. Circulation 2009 ;119:3053-61. doi: 10.1161/ CIRCULATIONAHA.108.842393.
  • Nashef SA, Roques F, Sharples LD, et al. EuroSCORE II. Eur J Cardiothorac Surg 2012;41:734-44. doi: 10.1093/ejcts/ezs043
  • Thielmann M, Massoudy P, Neuhauser M, et al. Prognostic value of preoperative cardiac troponin I in patients undergoing emergency coronary artery bypass surgery with non-ST-elevation or ST-elevation acute coronary syndromes. Circulation 2006;114(1 Suppl):I448-53. doi: 10.1161/ CIRCULATIONAHA.105.001057.
  • Antunes PE, de Oliveira JF, Antunes MJ. Coronary surgery in patients with diabetes mellitus: a risk-adjusted study on early outcome. Eur J Cardiothorac Surg 2008;34:370-5. doi: 10.1016/j.ejcts.2008.05.008.
  • Leavitt BJ, Sheppard L, Maloney C, Clough RA, Braxton JH, Charlesworth DC et al.; Northern New England Cardiovascular Disease Study Group. Effect of diabetes and associated conditions on long-term survival after coronary artery bypass graft surgery. Circulation. 2004 Sep 14;110(11 Suppl 1):II41-4. doi: 10.1161/01.CIR.000.013.8197.07051.e7.
  • Kanjanahattakij N, Rattanawong P, Riangwiwat T, et al. Fragmented QRS and mortality in patients undergoing percutaneous intervention for ST-elevation myocardial infarction: Systematic review and meta-analysis. Ann Noninvasive Electrocardiol 2018 ;23:e12567. doi: 10.1111/ anec.12567. Epub 2018 Jun 22
  • Kewcharoen J, Trongtorsak A, Kittipibul V, et al. Fragmented QRS predicts reperfusion failure and in-hospital mortality in ST-elevation myocardial infarction: a systematic review and meta-analysis. Acta Cardiol 2020 ;75:298-311. doi: 10.1080/00015.385.2019.1584696.
  • Erdoğan T, Çetin M, Kocaman SA, et al. Relationship of fragmented QRS with prognostic markers and in-hospital MACE in patients undergoing CABG. Scand Cardiovasc J 2012;46:107-13. doi: 10.3109/14017.431.2011.651485.
  • Vickneson K, Chan SP, Li Y, et al. Coronary artery bypass grafting in patients with low ejection fraction: what are the risk factors? J Cardiovasc Surg (Torino) 2019;60:396-405. doi: 10.23736/S0021-9509.19.10670-2.
  • Sergeant P, Meyns B, Wouters P, Demeyere R, Lauwers P. Long-term outcome after coronary artery bypass grafting in cardiogenic shock or cardiopulmonary resuscitation. J Thorac Cardiovasc Surg 2003 ;126:1279-86. doi: 10.1016/s0022- 5223(03)01289-3.
  • Poirier Y, Voisine P, Plourde G, et al. Efficacy and safety of preoperative intra-aortic balloon pump use in patients undergoing cardiac surgery: a systematic review and metaanalysis. Int J Cardiol 2016;207:67-79. doi: 10.1016/j. ijcard.2016.01.045.
  • Gong B, Li Z. Total mortality, major adverse cardiac events, and echocardiographic-derived cardiac parameters with fragmented qrs complex. Ann Noninvasive Electrocardiol 2016;21:404-12. doi: 10.1111/anec.12325.

Impact of fragmented QRS on in-hospital mortality in emergency coronary artery bypass grafting for STEMI: A retrospective analysis

Year 2024, Volume: 37 Issue: 2, 121 - 128, 31.05.2024
https://doi.org/10.5472/marumj.1485355

Abstract

Objective: Fragmented QRS complex (fQRS) is associated with increased morbidity and mortality, sudden cardiac death, and recurrent
cardiovascular events. The role of coronary artery bypass grafting (CABG) in the primary treatment of acute myocardial infarction
remains controversial. In this study, we aimed to assess the predictive value of fQRS in-hospital mortality among acute segment
elevation myocardial infarction (STEMI) patients undergoing emergency CABG for primary revascularization.
Patients and Methods: Between 2010 and 2020, we retrospectively included 99 consecutive STEMI patients who were not eligible for
primary percutaneous intervention and required emergency CABG. The study population was divided into two groups: survivors and
non-survivors. We compared the two groups regarding demographic, clinical, and operative characteristics.
Results: fQRS was identified as an independent predictor of in-hospital mortality (p = 0.037). Additionally, left ventricular ejection
fraction (LVEF) was an independent predictor of in-hospital mortality (p = 0.028). Glomerular filtration rate (GFR), glucose levels,
and Killip class ≥ III were significantly associated with in-hospital mortality (p = 0.002), (p = 0.001) and (p < 0.001).
Conclusion: fQRS emerged as an independent predictor of in-hospital mortality among patients undergoing emergency CABG for
primary revascularization in cases of STEMI.

References

  • Ibanez B, James S, Agewall S, et al.. ESC Scientific Document Group. 2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation: The Task Force for the management of acute myocardial infarction in patients presenting with ST-segment elevation of the European Society of Cardiology (ESC). Eur Heart J 2018 7;39:119-77. doi: 10.1093/eurheartj/ehx393.
  • Rohn V, Grus T, Belohlavek J, Horak J. Surgical revascularisation in the early phase of ST-segment elevation myocardial infarction: Haemodynamic status is more important than the timing of the operation. Heart Lung Circ 2017;26:1323-29. doi: 10.1016/j.hlc.2017.01.009.
  • Khan AN, Sabbagh S, Ittaman S, et al. Outcome of early revascularization surgery in patients with ST-elevation myocardial infarction. J Interv Cardiol 2015;28:14-23. doi: 10.1111/joic.12177.
  • Das MK, Saha C, El Masry H, et al. Fragmented QRS on a 12-lead ECG: a predictor of mortality and cardiac events in patients with coronary artery disease. Heart Rhythm 2007;4:1385-92. doi: 10.1016/j.hrthm.2007.06.024.
  • Gungor B, Ozcan K S, Karatas M B, Sahin I, Ozturk R, Bolca O. (2016). Prognostic value of QRS fragmentation in patients with acute myocardial infarction: a meta-analysis. Ann Noninvasive Electrocardiol 2016;21:604-12. doi:10.1111/ anec.12357
  • Rosengarten J A, Scott P A, Morgan J M. 2015). Fragmented QRS for the prediction of sudden cardiac death: a metaanalysis. Europace 2025; 17: 969-77. doi:10.1093/europace/ euu279
  • Altunova M, Püşüroğlu H, Karakayalı M, et al. Relationship between fragmented QES complex and longterm cardiovascular outcome in patients with essential hypertension. Anatol J Cardiol. 2022;26:442-9. doi: 10.5152/ AnatolJCardiol.2022.1322.
  • Kewcharoen J, Trongtorsak A, Kittipibul V, et al. Fragmented QRS predicts reperfusion failure and in-hospital mortality in ST-Elevation myocardial infarction: a systematic review and meta-analysis. Acta Cardiol 2020 ;75:298-311. doi: 10.1080/00015.385.2019.1584696.
  • Xia W, Feng XY. Fragmented QRS (fQRS) complex predicts adverse cardiac events of st-segment elevation myocardial infarction patients undergoing percutaneous coronary intervention and thrombolysis. Med Sci Monit 2018;24: 4634- 40. doi: 10.12659/MSM.908712.
  • Çiçek Y, Kocaman SA, Durakoğlugil M, et al. Relationship of fragmented QRS with prognostic markers and long-term major adverse cardiac events in patients undergoing coronary artery bypass graft surgery. J Cardiovasc Med (Hagerstown) 2015;16:112-7. doi: 10.2459/01.JCM.000.043.5615.40439.68.
  • Levy B, Clere-Jehl R, Legras A, et al. Epinephrine versus norepinephrine for cardiogenic shock after acute myocardial infarction. J Am Coll Cardiol 2018;72:173-82. doi:0.1016/j. jacc.2018.04.051.
  • Karakayali M, Artac I, Omar T, et al. The association between frontal QRS-T angle and reverse dipper status in newly diagnosed hypertensive patients. Blood Press Monit 2023;28:96-102. doi: 10.1097/MBP.000.000.0000000637.
  • Lang RM, Badano LP, Mor-Avi V, et al. Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. J Am Soc Echocardiogr 2015;28:1-39.
  • de Lemos JA, Morrow DA, Gibson CM, et al. TIMI 14 Investigators. Thrombosis in myocardial infarction. Early noninvasive detection of failed epicardial reperfusion after fibrinolytic therapy. Am J Cardiol 2001;88:353-8. doi: 10.1016/ s0002-9149(01)01678-2.
  • Das MK, Khan B, Jacob S, Mahenthiran J. Significance of a fragmented QRS complex versus a Q wave in patients with coronary artery disease. Circulation 2006;113:2495-501. doi: 10.1161/CIRCULATIONAHA.105.595892.
  • Gu YL, van der Horst IC, Douglas YL, Svilaas T, Mariani MA, Zijlstra F. Role of coronary artery bypass grafting during the acute and subacute phase of ST-elevation myocardial infarction. Neth Heart J 2010;18:348-54. doi: 10.1007/ BF03091790.
  • Lang Q, Qin C, Meng W. Appropriate timing of coronary artery bypass graft surgery for acute myocardial infarction patients: A meta-analysis. Front Cardiovasc Med 2022;9:794925. doi: 10.3389/fcvm.2022.794925.
  • Voisine P, Mathieu P, Doyle D, et al. Influence of time elapsed between myocardial infarction and coronary artery bypass grafting surgery on operative mortality. Eur J Cardiothorac Surg 2006;29:319-23. doi: 10.1016/j.ejcts.2005.12.021.
  • Axelsson TA, Mennander A, Malmberg M, Gunn J, Jeppsson A, Gudbjartsson T. Is emergency and salvage coronary artery bypass grafting justified? The Nordic Emergency/Salvage coronary artery bypass grafting study. Eur J Cardiothorac Surg 2016;49:1451-6. doi: 10.1093/ejcts/ezv388.
  • Uygur B, Demir AR, Guner A, Iyigun T, Uzun N, Celik O. Utility of logistic clinical SYNTAX score in prediction of inhospital mortality in ST-elevation myocardial infarction patients undergoing emergent coronary artery bypass graft surgery. J Card Surg 2021;36:857-63. doi: 10.1111/jocs.15308.
  • Lemaire A, Vagaonescu T, Ikegami H, Volk L, Verghis N, Lee LY. Delay in coronary artery bypass grafting for STEMI patients improves hospital morbidity and mortality. J Cardiothorac Surg 2020;15:86. doi: 10.1186/s13019.020.01134-x.
  • Ranucci M, Castelvecchio S, Menicanti L, Frigiola A, Pelissero G. Risk of assessing mortality risk in elective cardiac operations: age, creatinine, ejection fraction, and the law of parsimony. Circulation 2009 ;119:3053-61. doi: 10.1161/ CIRCULATIONAHA.108.842393.
  • Nashef SA, Roques F, Sharples LD, et al. EuroSCORE II. Eur J Cardiothorac Surg 2012;41:734-44. doi: 10.1093/ejcts/ezs043
  • Thielmann M, Massoudy P, Neuhauser M, et al. Prognostic value of preoperative cardiac troponin I in patients undergoing emergency coronary artery bypass surgery with non-ST-elevation or ST-elevation acute coronary syndromes. Circulation 2006;114(1 Suppl):I448-53. doi: 10.1161/ CIRCULATIONAHA.105.001057.
  • Antunes PE, de Oliveira JF, Antunes MJ. Coronary surgery in patients with diabetes mellitus: a risk-adjusted study on early outcome. Eur J Cardiothorac Surg 2008;34:370-5. doi: 10.1016/j.ejcts.2008.05.008.
  • Leavitt BJ, Sheppard L, Maloney C, Clough RA, Braxton JH, Charlesworth DC et al.; Northern New England Cardiovascular Disease Study Group. Effect of diabetes and associated conditions on long-term survival after coronary artery bypass graft surgery. Circulation. 2004 Sep 14;110(11 Suppl 1):II41-4. doi: 10.1161/01.CIR.000.013.8197.07051.e7.
  • Kanjanahattakij N, Rattanawong P, Riangwiwat T, et al. Fragmented QRS and mortality in patients undergoing percutaneous intervention for ST-elevation myocardial infarction: Systematic review and meta-analysis. Ann Noninvasive Electrocardiol 2018 ;23:e12567. doi: 10.1111/ anec.12567. Epub 2018 Jun 22
  • Kewcharoen J, Trongtorsak A, Kittipibul V, et al. Fragmented QRS predicts reperfusion failure and in-hospital mortality in ST-elevation myocardial infarction: a systematic review and meta-analysis. Acta Cardiol 2020 ;75:298-311. doi: 10.1080/00015.385.2019.1584696.
  • Erdoğan T, Çetin M, Kocaman SA, et al. Relationship of fragmented QRS with prognostic markers and in-hospital MACE in patients undergoing CABG. Scand Cardiovasc J 2012;46:107-13. doi: 10.3109/14017.431.2011.651485.
  • Vickneson K, Chan SP, Li Y, et al. Coronary artery bypass grafting in patients with low ejection fraction: what are the risk factors? J Cardiovasc Surg (Torino) 2019;60:396-405. doi: 10.23736/S0021-9509.19.10670-2.
  • Sergeant P, Meyns B, Wouters P, Demeyere R, Lauwers P. Long-term outcome after coronary artery bypass grafting in cardiogenic shock or cardiopulmonary resuscitation. J Thorac Cardiovasc Surg 2003 ;126:1279-86. doi: 10.1016/s0022- 5223(03)01289-3.
  • Poirier Y, Voisine P, Plourde G, et al. Efficacy and safety of preoperative intra-aortic balloon pump use in patients undergoing cardiac surgery: a systematic review and metaanalysis. Int J Cardiol 2016;207:67-79. doi: 10.1016/j. ijcard.2016.01.045.
  • Gong B, Li Z. Total mortality, major adverse cardiac events, and echocardiographic-derived cardiac parameters with fragmented qrs complex. Ann Noninvasive Electrocardiol 2016;21:404-12. doi: 10.1111/anec.12325.
There are 33 citations in total.

Details

Primary Language English
Subjects Surgery (Other)
Journal Section Original Research
Authors

Mehmet Altunova 0000-0001-5351-5022

Gul Cakmak 0000-0001-6900-0293

Publication Date May 31, 2024
Submission Date December 18, 2023
Acceptance Date February 23, 2024
Published in Issue Year 2024 Volume: 37 Issue: 2

Cite

APA Altunova, M., & Cakmak, G. (2024). Impact of fragmented QRS on in-hospital mortality in emergency coronary artery bypass grafting for STEMI: A retrospective analysis. Marmara Medical Journal, 37(2), 121-128. https://doi.org/10.5472/marumj.1485355
AMA Altunova M, Cakmak G. Impact of fragmented QRS on in-hospital mortality in emergency coronary artery bypass grafting for STEMI: A retrospective analysis. Marmara Med J. May 2024;37(2):121-128. doi:10.5472/marumj.1485355
Chicago Altunova, Mehmet, and Gul Cakmak. “Impact of Fragmented QRS on in-Hospital Mortality in Emergency Coronary Artery Bypass Grafting for STEMI: A Retrospective Analysis”. Marmara Medical Journal 37, no. 2 (May 2024): 121-28. https://doi.org/10.5472/marumj.1485355.
EndNote Altunova M, Cakmak G (May 1, 2024) Impact of fragmented QRS on in-hospital mortality in emergency coronary artery bypass grafting for STEMI: A retrospective analysis. Marmara Medical Journal 37 2 121–128.
IEEE M. Altunova and G. Cakmak, “Impact of fragmented QRS on in-hospital mortality in emergency coronary artery bypass grafting for STEMI: A retrospective analysis”, Marmara Med J, vol. 37, no. 2, pp. 121–128, 2024, doi: 10.5472/marumj.1485355.
ISNAD Altunova, Mehmet - Cakmak, Gul. “Impact of Fragmented QRS on in-Hospital Mortality in Emergency Coronary Artery Bypass Grafting for STEMI: A Retrospective Analysis”. Marmara Medical Journal 37/2 (May 2024), 121-128. https://doi.org/10.5472/marumj.1485355.
JAMA Altunova M, Cakmak G. Impact of fragmented QRS on in-hospital mortality in emergency coronary artery bypass grafting for STEMI: A retrospective analysis. Marmara Med J. 2024;37:121–128.
MLA Altunova, Mehmet and Gul Cakmak. “Impact of Fragmented QRS on in-Hospital Mortality in Emergency Coronary Artery Bypass Grafting for STEMI: A Retrospective Analysis”. Marmara Medical Journal, vol. 37, no. 2, 2024, pp. 121-8, doi:10.5472/marumj.1485355.
Vancouver Altunova M, Cakmak G. Impact of fragmented QRS on in-hospital mortality in emergency coronary artery bypass grafting for STEMI: A retrospective analysis. Marmara Med J. 2024;37(2):121-8.