Anastasia Asylia Dinakrisma
Faculty Medicine , University of Indonesia
Ms. Anastasia Asylia Dinakrisma, MD is graduated from Internal Medicine Department, Faculty Medicine , Universitas Indonesia in 2018. Her experience were medical doctor in rural area and team leader in community health development programme in rural area Papua, Indonesia from 2008-2012. This research was her final thesis emphasized her passion on improving clinical cardiology outcome based on basic examination ECG data.
Fragmented QRS (FQRS) on 2 successive leads, which relate to the territory of the main coronary artery on a 12 lead ECG, known as a marker of myocardial scar, ventricular arrhythmia substrate, ventricular remodelling and worse coronary collaterals flow.
Objectives. This research studied the role of fQRS as one of the risk factors of MACE (cardiac death and reinfarction) in ACS patients within 30 days observation.
Methods. A cohort retrospective study was conducted by using secondary data acute coronary syndrome patients in Intensive Cardiac Care Unit Cipto Mangunkusumo Hospital, Indonesia from July 2015 – October 2017.
Result. Three hundred and fifty three (353) subjects were included from July 2015 - October 2017. Fragmented QRS was found in 60,9 % subjects, more frequent in inferior leads (48,8% ) with mean onset 34 hours. Major adverse cardiac events were higher in fQRS vs non fQRS group (15,8% vs 5,8 %). Bivariate analysis showed higher probability of 30 days MACE in ACS patient (RR 2,72, 95% CI 1,3 -5,71). Multivariate analysis were done by using logistic regression with GRACE score (moderate and high risk), low eGFR (< 60 ml/min), low LVEF (< 40%), diabetes mellitus, age more than 45 years and hypertension as confounding factors, revealed adjusted RR was 2,79 (95% CI 1,29 – 4,43). Low eGFR was a potential confounder in this study. Fragmented QRS is a conduction disturbance marker, recorded in late potential on signal averaged electrocardiogram (SAECG) from the fibrotic myocardial zone of infarction, which increase the risk of ventricular arrhythmias and sudden cardiac death in ACS patient. It also increase the risk of arrhytmia maligna and left ventricle systolic dysfunction higher than non fQRS group, and predictor of poor formation of collateral coronary artery flow.
Conclusion Persistent fQRS developed in ACS during hospitalization is an independent predictor of 30 days MACE cardiac death and reinfarction.