title: The relationship between fragmentation on electrocardiography and in-hospital prognosis of patients with acute myocardial infarction.
abstract: BACKGROUND
  In patients with acute ST elevation myocardial infarction (STEMI), QRS fragmentation was determined as one of the indicators of mortality and morbidity. The development of fragmented QRS (fQRS) is related to defects in the ventricular conduction system and is linked to myocardial scar and fibrosis.
  
  
  METHODS
  We prospectively enrolled 355 consecutive patients hospitalized in the coronary intensive care unit of our hospital with STEMI between the years 2010 and 2012 and their electrocardiographic features and the frequency of in-hospital cardiac events were evaluated.
  
  
  RESULTS
  There were 217 cases in the fQRS group and 118 cases in the control group. QRS fragmentation was found to be a predictor for major cardiac events. In the fragmented QRS group, the frequency of in-hospital major cardiac events (MACE) and death were higher (MACE p<0.001; death p<0.003). In the fragmented QRS group, the cardiac enzymes (Troponin-I, CK-MB) were significantly higher than in the control group (p<0.001). In subgroup analyses, apart from the presence of fragmentation, the presence of more than 1 type of fragmentation and the number of fragmented deviations were also found to be related with MACE. A significant negative correlation was observed with the ejection fraction and, in particular, the number of fragmented deviations.
  
  
  CONCLUSIONS
  Fragmented QRS has emerged as a practical and easily identifiable diagnostic tool for predicting in-hospital cardiac events in acute coronary syndromes. Patients who present with a fragmented QRS demonstrate increased rates of major cardiac events, death risk, and low ejection fraction. In patients with STEMI, the presence of fQRS on the ECG and number of fQRS derivations are a significant predictor of in-hospital major cardiac events.
authors.affiliation: Department of Cardiology, Siyami Ersek Cardiovascular and Thoracic Surgery Center, Istanbul, Turkey.
authors.forename: Ersin
authors.initials: E
authors.lastname: Yıldırım
authors.affiliation: Department of Cardiology, Siyami Ersek Cardiovascular and Thoracic Surgery Center, Istanbul, Turkey.
authors.forename: Denizhan
authors.initials: D
authors.lastname: Karaçimen
authors.affiliation: Department of Cardiology, Siyami Ersek Cardiovascular and Thoracic Surgery Center, Istanbul, Turkey.
authors.forename: Kazım Serhan
authors.initials: KS
authors.lastname: Ozcan
authors.affiliation: Department of Cardiology, Siyami Ersek Cardiovascular and Thoracic Surgery Center, Istanbul, Turkey.
authors.forename: Damirbek
authors.initials: D
authors.lastname: Osmonov
authors.affiliation: Department of Cardiology, Siyami Ersek Cardiovascular and Thoracic Surgery Center, Istanbul, Turkey.
authors.forename: Ceyhan
authors.initials: C
authors.lastname: Türkkan
authors.affiliation: Department of Cardiology, Siyami Ersek Cardiovascular and Thoracic Surgery Center, Istanbul, Turkey.
authors.forename: Servet
authors.initials: S
authors.lastname: Altay
authors.affiliation: Department of Cardiology, Siyami Ersek Cardiovascular and Thoracic Surgery Center, Istanbul, Turkey.
authors.forename: Ufuk Sadık
authors.initials: US
authors.lastname: Ceylan
authors.affiliation: Department of Cardiology, Siyami Ersek Cardiovascular and Thoracic Surgery Center, Istanbul, Turkey.
authors.forename: Murat
authors.initials: M
authors.lastname: Uğur
authors.affiliation: Department of Cardiology, Siyami Ersek Cardiovascular and Thoracic Surgery Center, Istanbul, Turkey.
authors.forename: Mehmet
authors.initials: M
authors.lastname: Bozbay
authors.affiliation: Department of Cardiology, Siyami Ersek Cardiovascular and Thoracic Surgery Center, Istanbul, Turkey.
authors.forename: Izzet
authors.initials: I
authors.lastname: Erdinler
mesh_terms: D017023:Coronary Angiography; D004562:Electrocardiography; D005260:Female; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000503:physiopathology* / Q000601:surgery; D011379:Prognosis; D013318:Stroke Volume; D016896:Treatment Outcome; D016277:Ventricular Function, Left