Predictive Value of Fragmented QRS Complex Over One Year Mortality Among Ticagrelor Loaded Acute Coronary Syndrome Patients

Year 2022, , 366 - 372, 27.12.2022

Naile Eriş Güdül , Serra Kara , Selin Koç , Yaren Hamza , Eda Nur Danlı , Başak Çelebi , Oğulcan Alkan , Celal Karabulut , Ömer Faruk Arslantürk , Sümeyye Sena Nahırcı , Dilara Demir , Gizem Demir , Fatih Eren Piyade , Ümit Karakaş , Volkan Altın

https://doi.org/10.29058/mjwbs.1141825

Abstract

Aim: Various factors and risk classifications have been proposed to determine the prognosis in patients with acute myocardial infarction. Fragmented QRS (fQRS) encompasses different RSR' patterns showing various morphologies of QRS complexes with or without Q waves on a 12-lead resting electrocardiogram (ECG). fQRS is a marker of myocardial scarring and is associated with prognosis. It has been shown to cause adverse cardiac outcomes when seen in certain cardiovascular diseases, including coronary artery disease. The need for risk stratification continues for the most effective and appropriate treatment of patients presenting with acute myocardial infarction. In this study, we aimed to investigate the effect of the presence of fQRS on the ECG in determining the prognosis in patients with acute myocardial infarction who underwent invasive intervention with ticagrelor loading.
Material and Methods: All acute myocardial infarction patients who applied to Zonguldak Bulent Ecevit University Health, Application and Research Center between January 2018 and January 2020 with acute coronary syndrome and underwent ticagrelor challenge and invasive intervention were retrospectively screened and included in the study. Demographic information (age, gender), cardiovascular history, risk factors and chronic diseases of 498 patients included in the study were obtained from medical records. Patients were divided into two groups according to the presence of fQRS in the application electrocardiogram. Pre-discharge mortality data of patients were obtained from medical records. The one-year follow-up was obtained by interviewing them, their families, or their personal physicians (directly or by telephone).
Results: A total of 498 (STEMI 324, 65,1%; NONSTEMI 174, 34,9%) patients with acute myocardial infarction who were loaded with ticagrelor and underwent invasive intervention, 272(%54,6) in the fQRS group and 226 (45.4%) in the non-fQRS group, were included in the study.Patients without fQRS had a family history of heart disease (85, 37.4%), NSTEMI (119, 52.4%), systolic blood pressure (125.16±25.03 mmHg) were significantly higher than those with fQRS (p<0.05 for all comparisons). Prior myocardial infarction (64, 23.4%) and STEMI (216, 79.4%) were statistically higher among patients with fQRS than without (p<0.001 for all comparisons). In all patients, pre-discharge mortality (78.9% vs. 21.1%) was higher in the group with fQRS (n=15) compared to the non-fQRS group (n=4) (p<0.001). At the end of the one-year follow-up of the patients who were discharged from the hospital in good health, again the mortality (79.5% vs. 20.5%) was higher in the group with fQRS (n=31) compared to the non-fQRS group (n=8) (p<0.001). In the patient group diagnosed with STEMI; oneyear mortality was higher in the group with fQRS (n=24) compared to those without fQRS (n=5) (17.2% vs. 82.8%; p=0.024). In the patient group diagnosed with NSTEMI; The one-year mortality was higher in the fQRS group (n=7) than in the non-fQRS group (n=3) (70% vs 30%; p=0.029). Age (OR=1.211; 95% CI=1.156-1.269; p<0.001), Diabetes Mellitus (OR=2.148; 95% CI=1.038-4.443; p=0.039), and presence of fQRS (OR=6.101; 95% CI=2.576-14.450; p<0.001) were the strongest predictors of one-year mortality in multivariate analysis,
Conclusion: In our study, the presence of fQRS can be considered as a predictor of poor prognosis and mortality in acute MI patients who were loaded with ticagrelor and underwent invasive intervention and the presence of fQRS may help in identifying high-risk patients and planning risk appropriate treatment strategies.

Keywords

Acute coronary syndrome, electrocardiography, fragmented QRS, prognosis

Tikagrelor Yüklemesi Yapılan Akut Koroner Sendrom Hastalarında Fragmante QRS Kompleksinin Bir Yıllık Mortalitedeki Prediktif Değeri

Abstract

Amaç: Akut miyokart infarktüsü hastalarında prognozunu belirlemek için çeşitli faktörler ve risk
sınıflandırmaları önerilmiştir. Fragmente QRS (fQRS), 12 derivasyonlu istirahat elektrokardiyogramda
(EKG) Q dalgası olan veya olmayan QRS komplekslerinin çeşitli morfolojilerini gösteren farklı RSR'
modellerini kapsar. fQRS, miyokard skarının bir belirtecidir ve prognoz ile ilişkilidir. Koroner arter
hastalığı da dahil olmak üzere bazı kadiyovasküler hastalıklarda görüldüğünde olumsuz kardiyak
sonuçlara neden olabileceği gösterilmiştir. Akut miyokart infarktüsü ile başvuran hastaların en etkili
ve uygun şekilde tedavi edilebilmesi için risk sınıflandırmasına duyulan ihtiyaç devam etmektedir.Bu
çalışmada tikagrelor yüklemesi invaziv girişim yapılan akut miyokart infarktüsü hastalarında EKG’de
görülen fQRS varlığının prognozu belirlemedeki etkisini araştırmayı amaçladık.
Gereç ve Yöntemler: Ocak 2018 ile Ocak 2020 tarihleri arasında Zonguldak Bülent Ecevit Üniversitesi
Sağlık, Uygulama ve Araştırma Merkezi’ne akut koroner sendrom ile başvuran ve tikagrelor yüklemesi ve
invaziv girişim yapılmış bütün akut miyokart infarktüsü hastaları retrospektif olarak taranarak çalışmaya
dahil edildi. Çalışmaya dahil edilen 498 hastanın demografik bilgileri (yaş, cinsiyet), kardiyovasküler
öyküleri, risk faktörleri ve kronik hastalıkları tıbbi kayıtlardan elde edildi. Başvuru elektrokardiyogramında
fQRS varlığına göre hastalar iki gruba ayrıldı. Hastaların hastanedeki taburculuk öncesi mortalite
verileri tıbbi kayıtlardan elde edildi. Bir yıllık takipleri ise kendileriyle, aileleriyle veya kişisel doktorlarıyla
(doğrudan ya da telefon ile) görüşülerek elde edildi.
Bulgular: Çalışmaya fQRS grubunda 272 (%54,6) ve fQRS olmayan grupta 226 (%45,4) olmak üzere
toplam 498 tikagrelor yüklenen ve invaziv girişim yapılmış akut miyokart infarktüsü hastası (STEMI 324,
%65,1; NONSTEMI 174, %34,9) dahil edildi. fQRS olmayan hastalarda ailede kalp hastalığı öyküsü (85,
%37.4), NONSTEMI (119, %52.4), sistolik kan basıncı (125.16±25.03 mmHg) fQRS olanlara kıyasla
anlamlı olarak daha yüksekti (tüm karşılaştırmalar için p<0,05). fQRS’li hastalarda geçirilmiş miyokart
infarktüsü (64, %23.4), STEMI (216, %79,4) fQRS olmayanlara göre istatistiksel olarak daha yüksekti (tüm karşılaştırmalar için p<0,001). Tüm hastalarda, fQRS olan grupta (n=15) fQRS olmayan gruba (n=4) kıyasla taburculuk öncesi mortalite (%78.9’a karşı %21.1) daha yüksekti (p<0,001). Hastaneden taburcu edilen hastaların bir yıllık takibi sonunda yine fQRS olan grupta (n=31) fQRS olmayan gruba (n=8) kıyasla mortalite (%79.5’e karşı %20.5) daha yüksekti (p<0,001). STEMI hasta grubunda; bir yıllık mortalite fQRS olan grupta (n=24) fQRS olmayanlara (n=5) kıyasla daha yüksekti (%82.8’e karşı %17.2;p=0,024). NONSTEMI hasta grubunda ise; bir yıllık mortalite fQRS olan grup (n=7) fQRS olmayanlara (n=3) göre daha yüksekti (%70’e karşı %30; p=0,029). Çok değişkenli analizde ise, yaş (OR=1.211; %95 CI=1.156-1.269; p<0.001), Diyabetes Mellitus (OR=2.148; %95 CI=1.038-4.443; p=0.039) ve fQRS varlığı (OR=6.101; %95 CI=2.576-14.450; p<0.001) bir yıllık mortalitenin en güçlü öngördürücüleriydi.
Sonuç: Çalışmamız, tikagrelor yüklenen ve invaziv girişim yapılan akut MI hastalarında fQRS varlığı kötü prognozun ve mortalitenin öngörücüsü olarak düşünülebilir ve fQRS varlığı, yüksek riskli hastaların belirlenmesinde ve riske uygun tedavi stratejilerinin planlanmasına yardımcı olabilir.

Keywords

Akut koroner sendrom, elektrokardiyografi, fragmente QRS, prognoz

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