title: Fragmented QRS complex predicts contrast-induced nephropathy and in-hospital mortality after primary percutaneous coronary intervention in patients with ST-segment elevation myocardial infarction.
abstract: BACKGROUND
  Contrast-induced nephropathy (CIN) is associated with increased mortality after primary percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction (STEMI). Recently, fragmented QRS complex (fQRS) on 12-lead electrocardiography has been introduced as a marker of cardiovascular disease and is associated with increased morbidity and mortality.
  
  
  OBJECTIVE
  fQRS on ECG is associated with CIN and in-hospital mortality after primary PCI in patients with STEMI.
  
  
  METHODS
  Eight hundred ninety-five patients with first STEMI treated by primary PCI were enrolled in the study. Patients were divided into 2 groups according to the presence or absence of fQRS as shown by 12-lead electrocardiography in the first 24 hours. fQRS was defined by presence of an additional R wave (R″), or notching of the S wave, or >1 R' in 2 contiguous leads. Patients were then reallocated to 2 groups according to presence or absence of postprocedural CIN, which was defined as a rise in serum creatinine of 0.5 mg/dL or a 25% increase from baseline value within 72 hours after the procedure.
  
  
  RESULTS
  Patients with a fQRS were older and had significantly lower left ventricular ejection fraction. CIN occurred in 77 (8.6%) patients. The prevalence of CIN and in-hospital mortality was significantly higher in the fQRS(+) group. In multivariate analysis, fQRS was found to be an independent predictor of CIN (odds ratio: 3.125, P = 0.029) and in-hospital mortality (odds ratio: 9.062, P = 0.009).
  
  
  CONCLUSIONS
  The fQRS is an independent predictor of postprocedural CIN and in-hospital mortality in STEMI patients.
authors.affiliation: Department of Cardiology, Ankara Education and Research Hospital, Ankara, Turkey.
authors.forename: Alparslan
authors.initials: A
authors.lastname: Kurtul
authors.affiliation: Department of Cardiology, Ankara Education and Research Hospital, Ankara, Turkey.
authors.forename: Mustafa
authors.initials: M
authors.lastname: Duran
mesh_terms: D003287:Contrast Media / Q000009:adverse effects*; D017023:Coronary Angiography / Q000009:adverse effects*; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D062645:Percutaneous Coronary Intervention; D011183:Postoperative Complications / Q000453:epidemiology*; D051437:Renal Insufficiency / Q000139:chemically induced* / Q000401:mortality; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D000072657:ST Elevation Myocardial Infarction / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D014421:Turkey / Q000453:epidemiology
chemical_list: D003287:Contrast Media
keywords: Fragmented QRS complex; ST-segment elevation myocardial infarction; contrast-induced nephropathy; in-hospital mortality