Özet:

Aim: Various factors and risk classifications have been proposed to determine the prognosis in patients with acute myocardial infarction. Fragmented QRS (fQRS) encompasses different RSR' patterns showing various morphologies of QRS complexes with or without Q waves on a 12-lead resting electrocardiogram (ECG). fQRS is a marker of myocardial scarring and is associated with prognosis. It has been shown to cause adverse cardiac outcomes when seen in certain cardiovascular diseases, including coronary artery disease. The need for risk stratification continues for the most effective and appropriate treatment of patients presenting with acute myocardial infarction. In this study, we aimed to investigate the effect of the presence of fQRS on the ECG in determining the prognosis in patients with acute myocardial infarction who underwent invasive intervention with ticagrelor loading. Material and Methods: All acute myocardial infarction patients who applied to Zonguldak Bulent Ecevit University Health, Application and Research Center between January 2018 and January 2020 with acute coronary syndrome and underwent ticagrelor challenge and invasive intervention were retrospectively screened and included in the study. Demographic information (age, gender), cardiovascular history, risk factors and chronic diseases of 498 patients included in the study were obtained from medical records. Patients were divided into two groups according to the presence of fQRS in the application electrocardiogram. Pre-discharge mortality data of patients were obtained from medical records. The one-year follow-up was obtained by interviewing them, their families, or their personal physicians (directly or by telephone). Results: A total of 498 (STEMI 324, 65,1%; NONSTEMI 174, 34,9%) patients with acute myocardial infarction who were loaded with ticagrelor and underwent invasive intervention, 272(%54,6) in the fQRS group and 226 (45.4%) in the non-fQRS group, were included in the study.Patients without fQRS had a family history of heart disease (85, 37.4%), NSTEMI (119, 52.4%), systolic blood pressure (125.16±25.03 mmHg) were significantly higher than those with fQRS (p<0.05 for all comparisons). Prior myocardial infarction (64, 23.4%) and STEMI (216, 79.4%) were statistically higher among patients with fQRS than without (p<0.001 for all comparisons). In all patients, pre-discharge mortality (78.9% vs. 21.1%) was higher in the group with fQRS (n=15) compared to the non-fQRS group (n=4) (p<0.001). At the end of the one-year follow-up of the patients who were discharged from the hospital in good health, again the mortality (79.5% vs. 20.5%) was higher in the group with fQRS (n=31) compared to the non-fQRS group (n=8) (p<0.001). In the patient group diagnosed with STEMI; oneyear mortality was higher in the group with fQRS (n=24) compared to those without fQRS (n=5) (17.2% vs. 82.8%; p=0.024). In the patient group diagnosed with NSTEMI; The one-year mortality was higher in the fQRS group (n=7) than in the non-fQRS group (n=3) (70% vs 30%; p=0.029). Age (OR=1.211; 95% CI=1.156-1.269; p<0.001), Diabetes Mellitus (OR=2.148; 95% CI=1.038-4.443; p=0.039), and presence of fQRS (OR=6.101; 95% CI=2.576-14.450; p<0.001) were the strongest predictors of one-year mortality in multivariate analysis, Conclusion: In our study, the presence of fQRS can be considered as a predictor of poor prognosis and mortality in acute MI patients who were loaded with ticagrelor and underwent invasive intervention and the presence of fQRS may help in identifying high-risk patients and planning risk appropriate treatment strategies.

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