Evolution of Fragmented QRS in Patients with New-Onset Left Bundle Branch Block Acute Coronary Syndrome Undergoing Primary Percutaneous Coronary Intervention | ||||
| The Medical Journal of Cairo University | ||||
| Volume 93, Issue 06, June 2025, Page 843-849 PDF (164.38 K) | ||||
| Document Type: Original Article | ||||
| DOI: 10.21608/mjcu.2025.445142 | ||||
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| Author | ||||
| ISMAIL M. IBRAHIM, M.D.; MANAR M. AL-ZAKI, M.D.; MESBAH T. HASSANEIN, M.D. and HOSSINY E. HOSSINY, M.Sc. | ||||
| The Department of Cardiology, Faculty of Medicine, Zagazig University | ||||
| Abstract | ||||
| Background: The lack of “ST segment resolution sign” after primary PCI represents one of the challenges in diagno-sis and management of patients with acute coronary syndrome (ACS) presenting with left bundle branch block (LBBB). The evolution of fragmented QRS (fQRS) in non-LBBB ACS pa-tients was found to be associated with sub-optimal revasculari-zation and poor prognosis. Aim of Study: This study aimed to assess clinical and angi-ographic factors associated with the evolution of fQRS in ACS patients presenting with LBBB. Patients and Methods: This prospectively studied 100 pa-tients with ACS presenting with LBBB and treated with pri-mary PCI. Serial ECGs were obtained over the first 2 days and examined for evolution (group 1) or absence/resolution (group 2) of fQRS. Clinical and angiographic data of groups 1 were analyzed. Results: Evolution of fQRS occured in 39 (39%) of patients (group 1). In this group, higher percentage of male patients (p=0.004), higher rate of current smoking (p=0.04), higher ad-mission SBP and Killip class (p=0.031 and <0.001; respective-ly), higher admission HsTnT and CK-MB (p<0.001; for each), lower LVEF at discharge (p<0.001), longer pain-to-door time (p=0.01) and lower MBG (p<0.001) were found in group 1. On regression analysis, presence of MBG 0-1, lower LVEF, higher admission SBP, higher admission CK-MB, and longer pain to door time were found to be independently associated with evo-lution of QRS. Conclusions: Evolution of fQRS in ACS patients present-ing with LBBB is independently associated with lower LV function and impaired microvascular perfusion. So, fQRS, as asimple marker, may be useful instratification of high-risk pa-tients with increased extent of infarcted myocardium in LBBB ACS. | ||||
| Keywords | ||||
| Acute coronary syndrome; Left bundle branch block; Fragmented QRS; Myocardial blush grade; Microvascular perfusion | ||||
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