Hubungan QRS Kompleks Fragmentasi pada Elektrokardiogram 12 Sadapan dan Kejadian Klinis Kardiovaskular Mayor selama Perawatan pada Pasien Infark Miokard Akut Elevasi ST Segmen di Rumah Sakit Umum Pusat Haji Adam Malik Medan

Abstract

Background : Fragmented QRS (fQRS) on the electrocardiogram (ECG) in patients with acute ST segement elevation myocardial infarction (STEMI) will have prognostic significance during hospitalization. The development of fQRS) is related to defects in the ventricular conduction system and is linked to myocardial scar and fibrosis. Objective : This study aimed to detemine that fQRS can be used as a predictor in predicting in hospital major adverse cardiac events (MACE) in STEMI patients. Methods : the study was carried out using retrospectively collected data of 91 patients diagnosed as acute STEMI. fQRS group had fQRS both in admission and latest ECGs (n= 46) and non-fQRS group had no fQRS in last ECG (n=45) further recording of MACE in hospital. . Results : From the analysis of the chi-square test found a significant correlation between fQRS and mortality{RR 6,36 (Cl 95% 1,52 - 26,59) ,p=0,002}, fQRS and arrhythmia { RR 5,87 (CI 95% 1,391 - 24,76),p = 0,004} and heart failure { RR 2,087 (CI 95% 1,324 - 3,290),p = 0,001} and fQRS and MACE {RR 2,359 (IK 95% 1,6 - 3,479),p < 0,001}. No significant association between fQRS with cardiogenic shock (p = 0,195). In the bivariate analysis there was a significant relationship between age, systolic blood pressure (SBP) and heart rate with MACE. The multivariate analysis only SBP and fQRS that would predict MACE but fQRS was the most dominant variable in influencing of MACE {RR 16,058 (1K 95% 5,03-51,18),p = 0,0001}. Conclusion : FQRS is a predictor for the occurrence of MACE (mortality, arrhythmia and heart failure) during hospitalization in STEMI patients