title: Relationship of fragmented QRS with prognostic markers and long-term major adverse cardiac events in patients undergoing coronary artery bypass graft surgery.
abstract: BACKGROUND
  Fragmented QRS (fQRS) complex is associated with increased sudden cardiac death, recurrent cardiovascular events, morbidity and mortality. However, the prognostic role of fQRS has not been comprehensively studied in patients undergoing coronary artery bypass graft (CABG) surgery. In this study, we planned to investigate the relationship of fQRS with prognostic markers and long-term major adverse cardiovascular events (MACEs) following isolated CABG surgery.
  
  
  METHODS
  Two hundred and thirteen patients who underwent CABG surgery at our institution were enrolled consecutively. MACE was defined as cardiac death, recurrent myocardial infarction, decompensated heart failure and re-hospitalization. The patients were followed up for a mean duration of 26 ± 10 months for MACE.
  
  
  RESULTS
  Patients with fQRS had a higher rate of Q wave on ECG (30 vs. 10%, P < 0.001), more prolonged QRS time (99 ± 11 vs. 88 ± 13 ms, P < 0.001), higher EUROSCORE (4.0 ± 1.9 vs. 2.7 ± 1.5, P < 0.001) and lower left ventricular ejection fraction (44 ± 12 vs. 56 ± 12, P < 0.001) in comparison with patients with non-fQRS. In addition, patients with fQRS had increased short-term and long-term MACE (17 vs. 4%, P = 0.002; 23 vs. 6%, P < 0.001, respectively) after discharge. Sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy of fQRS for predicting MACE were 67, 71, 23, 94 and 70%, respectively. fQRS [odds ratio (OR) 3.110, 95% confidence interval (CI) 1.157-8.362, P = 0.025] and prolonged QRS duration (>100 ms) (OR 3.898, 95% CI 1.463-10.39, P = 0.007) were the only independent predictors of long-term MACE in multivariate logistic regression analysis. However, QRS duration had a better association with MACE than the presence of fQRS.
  
  
  CONCLUSIONS
  fQRS and prolonged QRS duration may have an additional value in predicting cardiac status and long-term prognosis. Fragmentations on admission ECG and prolonged QRS duration may be useful for identifying patients with higher long-term risk who will need more intense treatment and close follow-up after CABG surgery.
authors.affiliation: aDepartment of Cardiology, Medical Faculty, Rize University bDepartment of Cardiology, Rize Education and Research Hospital cDepartment of Cardiovascular Surgery, Medical Faculty, Rize University, Rize, Turkey.
authors.forename: Yüksel
authors.initials: Y
authors.lastname: Çiçek
authors.forename: Sinan A
authors.initials: SA
authors.lastname: Kocaman
authors.forename: Murtaza E
authors.initials: ME
authors.lastname: Durakoğlugil
authors.forename: Mustafa
authors.initials: M
authors.lastname: Çetin
authors.forename: Aytun
authors.initials: A
authors.lastname: Çanga
authors.forename: Şahin
authors.initials: Ş
authors.lastname: Bozok
authors.forename: Stk
authors.initials: S
authors.lastname: Doğan
authors.forename: Turan
authors.initials: T
authors.lastname: Erdoğan
mesh_terms: D000368:Aged; D001145:Arrhythmias, Cardiac / Q000150:complications*; D001026:Coronary Artery Bypass / Q000009:adverse effects*; D016757:Death, Sudden, Cardiac / Q000209:etiology; D004562:Electrocardiography / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000209:etiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000209:etiology; D010359:Patient Readmission / Q000706:statistics & numerical data; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D012008:Recurrence; D012680:Sensitivity and Specificity