Original-clinicalFragmented QRS on a 12-lead ECG: A predictor of mortality and cardiac events in patients with coronary artery disease
Section snippets
Methods
One thousand and thirty-four consecutive patients, who were referred for stress test at Veterans Affairs Medical Center, Indiana University, Indianapolis, between January 1998 and December 1999, were included in this retrospective study. These patients were being evaluated for CAD with either exercise or pharmacological nuclear stress testing. The study protocol was approved by the Institutional Review Board of Indiana University. The demographics, including history of significant CAD
Results
Of 1,034 consecutive patients who underwent stress testing, 36 patients were excluded because of an uninterpretable baseline ECG or stress imaging as well as incomplete stress protocol. Right bundle branch (n = 62), left bundle branch block (n = 38), and paced rhythm (n = 2) was included in the control group. Therefore, a final cohort of 998 patients (mean age 65.5 ± 11.9 years, male 967) were included in the study. The fQRS was present in at least 1 of the coronary artery territories in 273
New observations
Our study shows that fQRS is a strong independent predictor of major cardiac events. Also, approximately one-third (34.1%) of patients with fQRS die as compared with approximately one-fourth (25.9%) of patients without fQRS during a median follow-up of 5.5 years. This means that the presence of fQRS is associated with significantly higher (8.2% absolute and 31.7% relative) risk for all-cause mortality as compared with its absence. Although patients with fQRS have a significantly higher rate of
Conclusions
The presence of fQRS on a 12-lead ECG in patients with suspected or known CAD is associated with a significant increase in cardiac events and all-cause mortality as compared with its absence. The presence of fQRS is also an independent predictor of significantly higher cardiac events in these patients. There is no significant difference in event-free survival for cardiac events and all-cause mortality in the patients with fQRS as compared with those who show pathological Q waves on a standard
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