Association of the Zwolle Score with Fragmented QRS Complex: A Combined Prognostic Tool for Primary Angioplasty in ST Elevation Myocardial Infarctions

Year 2016, , 66 - 76, 01.01.2016

Ahmet Karakurt Abdulmelik Yildiz Cennet Yildiz Hamit Serdar Basbug

https://doi.org/10.5455/umj.20160424111257

Abstract

Introduction: We aimed to introduce the prognostic value of simultaneously calculated fragmented QRS and Zwolle scores as a new scoring system in primary PCI of the STEMI patients. Method: Two hundred fifty-nine STEMI patients were classified as fragmented QRS complex group fQRS and non-fragmented QRS complex group non-fQRS according to the fragmentation of QRS complex in electrocardiography. These two groups according to whether Zwolle score ≥3 were also classified as high Zwolle score with fQRS complex, high Zwolle score with the non-fQRS complex, the low Zwolle score with fQRS complex, and low Zwolle score with the non-fQRS complex group. The hospitalization data of the patients were analyzed. Results: In the fQRS group compared with the non-fQRS group, wider QRS 105.2±9.7 vs. 88±7.1, p

Keywords

Zwolle score, fragmented QRS, acute myocardial infarction, adverse cardiac events.

References

• Räber L, Kelbæk H, Ostojic M, Baumbach A, Heg D, Tüller D, et al. Effect of biolimus-eluting stents with biodegradable polymer vs bare-metal stents on cardiovascular events among patients with acute myocardialinfarction: the COMFORTABLE AMI randomized trial. JAMA 2012;308:777-787.
• Morrow DA, Antman EM, Charlesworth A, Cairns R, Murphy SA, de Lemos JA, et al. TIMI Risk Score for ST-elevation myocardial infarction: a convenient, bedside, clinical score for risk assessment at presentation. Circulation. 2000;102:2031-2037.
• De Luca G, Suryapranata H, van 't Hof AW, de Boer MJ, Hoorntje JC, Dambrink JH, et al. Prognostic assessment of patients with acute myocardial infarction treated with primary angioplasty: implications for early discharge.Circulation 2004;109:2737-2743.
• Addala S, Grines CL, Dixon SR, Stone GW, Boura JA, Ochoa AB, et al. Predicting mortality in patients with ST-elevationmyocardial infarction treated with primary percutaneous coronary intervention (PAMI riskscore). Am J Cardiol 2004; 93:629 -632.
• Halkin A, Singh M, Nikolsky E, Grines CL, Tcheng JE, Garcia E, et al. Prediction of mortality after primary percutaneouscoronary intervention for acute myocardial infarction: the CADILLAC risk score. J Am CollCardiol 2005;45:1397-1405.
• Das MK, Suradi H, Maskoun W, Michael MA, et al. Fragmented wide QRS on a 12-lead ECG: a sign of myocardial scar and poor prognosis.CircArrhythmElectrophysiol.2008;1:258-268.
• Das MK, Khan B, Jacob S, Kumar A, Mahenthiran J. Significance of a Fragmented QRS Complex Versus a Q Wave in Patients with Coronary Artery Disease. Circulation 2006 ;113:2495-2501.
• Das MK, Michael MA, Suradi H, Peng J, Sinha A, Shen C, et al. Usefulness of fragmented QRS on a 12-lead electrocardiogram in acute coronary syndrome for predicting mortality. Am J Cardiol ;104:1631-1637.
• Korhonen P, Husa T, Konttila T, Tierala I, Mäkijärvi M, Väänänen H, et al. Fragmented QRS in prediction of cardiac deaths and heart failure hospitalizations after myocardial infarction. Ann Non invasive Electrocardiol2010;15:130-137.
• Das MK, Saha C, El Masry H, Peng J, Dandamudi G, Mahenthiran J, 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;4:1385-1392.
• Pietrasik G, Goldenberg I, Zdzienicka J, Moss AJ, Zareba W. Prognostic significance of fragmented QRS complex for predicting the risk of recurrent cardiac events in patients with Q-wave myocardial infarction. Am J Cardiol2007;100:583-586.
• Torigoe K, Tamura A, Kawano Y, Shinozaki K, Kotoku M, Kadota J.The number of leads with fragmented QRS is independently associated with cardiac death or hospitalization for heart failure in patients with prior myocardial infarction. J Cardiol. 2012;59:36-41.
• Killip T 3rd, Kimball JT. Treatment of myocardial infarction in a coronary care unit. A two year experience with 250 patients.Am J Cardiol1967;20:457-464.
• Pearlman AS, Gardin JM, Martin RP, Parisi AF, Popp RL, Quinones MA, et al. Guidelines for optimal physician training in echocardio graphy. Recommendations of the American Society of Echocardio graphy Committee for Physician Training in Echocardiography. Am J Cardiol 1987;60:158-163.
• Take Y, Morita H. Fragmented QRS: What Is The Meaning? Indian Pacing Electrophysiol J 2012; 12: 213–225.
• Granger CB, Goldberg RJ, Dabbous O, Pieper KS, Eagle KA, Cannon CP, et al. Global Registry of Acute Coronary Events Investigators.Predictors of hospital mortality in the global registry of acute coronary events.Arch Int Med 2003;163:2345-2353.
• Nam CW, Mangiacapra F, Entjes R, Chung IS, Sels JW, Tonino PA, et al. FAME Study Investigators. Functional SYNTAX score for risk assessment in multivessel coronary arterydisease. J Am Coll Cardiol 2011;58:1211-1218.
• Capodanno D, Miano M, Cincotta G, Caggegi A, Ruperto C, Bucalo R,et al. EuroSCORE refines the predictive ability of SYNTAX score in patients undergoing left main percutaneous coronary intervention. Am Heart J 2010;159:103-109
• Flowers NC, Horan LG, Thomas JR, Tolleson WJ. The anatomic basis for high-frequency components in the electrocardiogram. Circulation 1969;39:531-539.
• Lesh MD, Spear JF, Simson MB. A computer model of the electrogram: what causes fractionation? J Electrocardiol 1988; :69-73.
• Friedman PL, Fenoglio JJ, Wit AL. Time course for reversal of electrophysiological and ultrastructural abnormalities in suben docardial Purkinje fibers surviving extensive myocardial infarction in dogs. Circ Res 1975;36:127-144.
• Wiener I, Mindich B, Pitchon R. Fragmented endocardial electrical activity in patients with ventricular tachycardia: a new guide to surgical therapy. Am Heart J 1984;107:86-90.
• Basaran Y, Tigen K, Karaahmet T, Isiklar I, Cevik C, Gurel E, et al. Fragmented QRS complexes are associated with cardiac fibrosis and significant intraventricular systolic dyssynchrony in nonische mic dilated cardiomyopathy patients with a narrow QRS interval. Echocardiography 2011;28:62-68.