Comparison of the presence of fragmented QRS complexes in the inferior versus the anterior leads for predicting coronary artery disease severity.
BACKGROUND
Fragmented QRS complexes (fQRS) are a sign of myocardial scar and are associated with adverse outcomes and mortality in patients with coronary artery disease (CAD). However, little is known about the significance of fQRS or of their localization on electrocardiography (ECG) in patients without known CAD. We aimed to investigate the association between localization of fQRS on ECG and CAD severity in patients undergoing a first diagnostic coronary angiography.


METHODS
We enrolled 135 consecutive patients who had a narrow fQRS on ECG and underwent a first diagnostic coronary angiography. Patients were divided into two groups based on localization of fQRS on ECG (group 1: fQRS in the inferior leads, group 2: fQRS in the anterior leads). The groups were compared regarding the presence of significant CAD, multivessel disease (MVD) and SYNTAX score (SXscore).


RESULTS
Eighty-six (63.7%) patients had fQRS in the inferior leads and 49 (36.3%) had fQRS in the anterior leads. There was no statistically significant difference between the groups regarding presence of significant CAD (47.7% vs. 51%, p=0.708). However, the incidence of MVD was significantly higher in group 2 compared to group 1 (10.5% vs. 28.6%, p=0.007). The median SXscore (6 [3,12] vs. 8 [4,24], p=0.047), and incidence of patients with SXscore >22 were significantly higher in group 2 compared to group 1 (3.5% vs. 20.4%, p=0.009).


CONCLUSIONS
The presence of fQRS in the anterior leads may indicate more severe CAD compared to fQRS in the inferior leads in patients undergoing a first diagnostic coronary angiography.
Department of Cardiology, Avrupa Medicine Center, Karabaglar, Izmir, Turkey. Electronic address: mhmtybgl@gmail.com.
Mehmet
M
Eyuboglu
Department of Cardiology, Gulhane Military Medical Academy, Haydarpasa Training Hospital, Istanbul, Turkey.
Ugur
U
Kucuk
Department of Cardiology, Medifema Hospital, Torbali, Izmir, Turkey.
Omer
O
Senarslan
Department of Cardiology, DokuzEylul University Hospital, Balcova, Izmir, Turkey.
Bahri
B
Akdeniz
D003324:Coronary Artery Disease / Q000503:physiopathology*; D004562:Electrocardiography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012720:Severity of Illness Index
Angiografia coronária; Coronary angiography; Coronary artery disease; Doença arterial coronária; Fragmented QRS; QRS fragmentado; SYNTAX score; Score SYNTAX