Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Meta-Analysis
. 2018 Nov;23(6):e12567.
doi: 10.1111/anec.12567. Epub 2018 Jun 22.

Fragmented QRS and mortality in patients undergoing percutaneous intervention for ST-elevation myocardial infarction: Systematic review and meta-analysis

Napatt Kanjanahattakij  1 , Pattara Rattanawong  2   3 , Tanawan Riangwiwat  2 , Narut Prasitlumkum  2 , Nath Limpruttidham  2 , Pakawat Chongsathidkiet  4 , Wasawat Vutthikraivit  5 , Erin Crossey  2
Affiliations
Meta-Analysis

Fragmented QRS and mortality in patients undergoing percutaneous intervention for ST-elevation myocardial infarction: Systematic review and meta-analysis

Napatt Kanjanahattakij et al. Ann Noninvasive Electrocardiol. 2018 Nov.

Abstract

Background: Fragmented QRS reflects disturbances in the myocardium predisposing the heart to ventricular tachyarrhythmias. Recent studies suggest that fragmented QRS (fQRS) is associated with mortality in ST-elevation myocardial infarction (STEMI) patients who underwent percutaneous coronary intervention (PCI). However, a systematic review and meta-analysis of the literature has not been done. We assessed the association between fQRS and overall mortality in STEMI patients who subsequently underwent PCI by a systematic review and meta-analysis.

Methods: We comprehensively searched the databases of MEDLINE and EMBASE from inception to September 2017. Studies included in our analysis were published cohort (prospective or retrospective) and case-control studies that compared overall mortality among STEMI patient with and without fQRS who underwent PCI. Data from each study were combined using the random-effects, generic inverse variance method of DerSimonian, and Laird to calculate risk ratios and 95% confidence intervals.

Results: Six studies from 2014 to 2017 were included in this meta-analysis involving 2,516 subjects with STEMI who underwent PCI (888 fQRS and 1,628 non-fQRS). Fragmented QRS was associated with overall mortality in STEMI patients who underwent PCI (pooled risk ratio = 3.87; 95% CI 1.96-7.66, I2 = 43%).

Conclusion: Fragmented QRS was associated with increased overall mortality up to threefold. Our study suggests that fQRS could be an important tool for risk assessment in STEMI patients who underwent PCI.

Keywords: Fragmented QRS; ST elevation; percutaneous intervention.

PubMed Disclaimer

Conflict of interest statement

The authors declare that they have no conflicts of interest.

Figures

Figure 1
Figure 1
Electrocardiography demonstrating fragmented QRS complexes in lead V4, V5, V6 (Figure originally published in an article by Akgul et al. (2015), reproduced with permission from Wiley online library)
Figure 2
Figure 2
Search methodology and selection process
Figure 3
Figure 3
Forest plot of studies comparing mortality in STEMI patients who underwent PCI, with and without fQRS. Horizontal lines represent the 95% CIs with marker size reflecting the statistical weight of the study using random‐effects model. A diamond data marker represents the overall adjusted odds ratio (OR) and 95% CI for the outcome of interest
Figure 4
Figure 4
Funnel plot of fragmented QRS and mortality. Circles represent published studies
See this image and copyright information in PMC

References

    1. Akgul, O. , Uyarel, H. , Pusuroglu, H. , Surgit, O. , Turen, S. , Erturk, M. , … Uslu, N. (2015). Predictive value of a fragmented QRS complex in patients undergoing primary angioplasty for ST elevation myocardial infarction. Annals of Noninvasive Electrocardiology, 20(3), 263–272. 10.1111/anec.12179 - DOI - PMC - PubMed
    1. Das, M. K. , Khan, B. , Jacob, S. , Kumar, A. , & Mahenthiran, J. (2006). Significance of a fragmented QRS complex versus a Q wave in patients with coronary artery disease. Circulation, 113(21), 2495–2501. 10.1161/CIRCULATIONAHA.105.595892 - DOI - PubMed
    1. Das, M. K. , Maskoun, W. , Shen, C. , Michael, M. A. , Suradi, H. , Desai, M. , … Bhakta, D. (2010). Fragmented QRS on twelve‐lead electrocardiogram predicts arrhythmic events in patients with ischemic and nonischemic cardiomyopathy. Heart Rhythm, 7(1), 74–80. 10.1016/j.hrthm.2009.09.065 - DOI - PubMed
    1. Das, M. K. , Suradi, H. , Maskoun, W. , Michael, M. A. , Shen, C. , Peng, J. , … Mahenthiran, J. (2008). Fragmented wide QRS on a 12‐lead ECG: a sign of myocardial scar and poor prognosis. Circulation: Arrhythmia and Electrophysiology, 1(4), 258–268. - PubMed
    1. DerSimonian, R. , & Laird, N. (1986). Meta‐analysis in clinical trials. Controlled Clinical Trials, 7(3), 177–188. 10.1016/0197-2456(86)90046-2 - DOI - PubMed

MeSH terms