title: Myocardial tissue perfusion predicts the evolution of fragmented QRS in patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention.
abstract: BACKGROUND
  Fragmented QRS complex (fQRS) is associated with worse outcomes in several cardiovascular conditions. However, alterations in fQRS in patients with ST elevation myocardial infarction (STEMI) who underwent primary percutaneous coronary intervention (PCI) and association of fQRS with myocardial blush grade (MBG) has not been investigated until now. In this study, we aimed to investigate the association of MBG after primary PCI with evolution of fQRS.
  
  
  METHODS
  Our study consisted of 401 consecutive patients with STEMI who underwent primary PCI. Patients were categorized into two subgroups according to persistence or new-onset of fQRS (Group 1) and absence or resolution of fQRS (Group 2) at 48 hours after primary PCI. The evolution of fQRS on pre- and post-PCI ECG and their relation with myocardial reperfusion parameters were investigated.
  
  
  RESULTS
  Patients in group 1 showed older age, higher rate of smoking, lower HDL-cholesterol, lower LVEF, higher angina-to-door time, higher TIMI frame count, and high rate of patients with MBG <3 compared to patients with group 2 (P < 0.05). In correlation analysis, LVEF showed positive correlation with MBG (r = 0.448, P < 0.001) and negative correlation with the number of leads with fQRS (r = -0.335, P < 0.001). In multivariate regression analysis, new-onset or persistance of fQRS after primary PCI is significantly associated with MBG <3, peak CK-MB level, pre-PCI fQRS at anterior localization and smoking.
  
  
  CONCLUSIONS
  Our findings showed that despite complete ST-segment resolution in all patients, fQRS is independently associated with impaired microvascular myocardial perfusion. So, fQRS, as a simple and easily available noninvasive marker, may be useful in stratification of high-risk patients with increased extent of infarcted myocardium who underwent primary PCI.
authors.affiliation: Cardiology Clinic, Türkiye Yüksek Ihtisas Training and Research Hospital, Ankara, Turkey.
authors.forename: Firat
authors.initials: F
authors.lastname: Ozcan
authors.forename: Osman
authors.initials: O
authors.lastname: Turak
authors.forename: Uğur
authors.initials: U
authors.lastname: Canpolat
authors.forename: Iskender
authors.initials: I
authors.lastname: Kadife
authors.forename: Sedat
authors.initials: S
authors.lastname: Avci
authors.forename: Ahmet
authors.initials: A
authors.lastname: Işleyen
authors.forename: Muhammed
authors.initials: M
authors.lastname: Cebeci
authors.forename: Özgül
authors.initials: Ö
authors.lastname: Malçok Gürel
authors.forename: Fatma Nurcan
authors.initials: FN
authors.lastname: Başar
authors.forename: Derya
authors.initials: D
authors.lastname: Tok
authors.forename: Serkan
authors.initials: S
authors.lastname: Topaloğlu
authors.forename: Dursun
authors.initials: D
authors.lastname: Aras
authors.forename: Sinan
authors.initials: S
authors.lastname: Aydoğdu
mesh_terms: D015415:Biomarkers / Q000097:blood; D017023:Coronary Angiography; D052279:Creatine Kinase, MB Form / Q000097:blood; D018450:Disease Progression; D004562:Electrocardiography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood / Q000503:physiopathology* / Q000601:surgery*; D062645:Percutaneous Coronary Intervention; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers; D052279:Creatine Kinase, MB Form
keywords: electrocardiography; fragmented QRS; myocardial infarction; reperfusion