QRS fragmentation does not predict mortality in survivors of acute myocardial infarction

Julia Allescher, Daniel Sinnecker, Bernhard von Goeldel, Petra Barthel, Alexander Müller, Alexander Hapfelmeier, Eimo Martens, Karl Ludwig Laugwitz, Georg Schmidt, Alexander Steger

Research output: Contribution to journalArticlepeer-review


Background: Despite advances in coronary revascularization and in heart failure management, myocardial infarction survivors remain at substantially increased mortality risk. Precise risk assessment and risk-adapted follow-up care are crucial to improve their outcomes. Recently, the fragmented QRS complex, i.e. the presence of additional spikes within the QRS complexes on a 12-lead electrocardiogram, has been discussed as a potential non-invasive risk predictor in cardiac patients. Hypothesis: The aim of this study was to evaluate the prognostic meaning of the fragmented QRS complex in myocardial infarction survivors. Methods: 609 patients with narrow QRS complexes <120 ms were included in a prospective cohort study while hospitalized for myocardial infarction and followed for 5 years. Results: The prevalence of the fragmented QRS complex in these patients amounted to 46.8% (285 patients). These patients had no increased hazard of all-cause death (HR 0.84, 95%–CI 0.45–1.57, p = 0.582) with a mortality rate of 6.0% compared to 7.1% in patients without QRS fragmentations. Furthermore, the risks of cardiac death (HR 1.28, 95%–CI 0.49–3.31, p = 0.613) and of non-cardiac death (HR 0.6, 95%–CI 0.26–1.43, p = 0.25) were not significantly different in patients with QRS fragmentations. However, patients with QRS fragmentations had increased serum creatine kinase concentrations (1438U/l vs. 1160U/l, p = 0.039) and reduced left ventricular ejection fractions (52% vs. 54%, p = 0.011). Conclusions: The hypothesis that QRS fragmentation might be a prognostic parameter in survivors of myocardial infarction was not confirmed. But those with QRS fragmentation had larger myocardial infarctions, as measured by creatine kinase and left ventricular ejection fraction.

Original languageEnglish
Article numbere24218
JournalClinical Cardiology
Issue number1
StatePublished - Jan 2024
Externally publishedYes


  • acute myocardial infarction
  • electrocardiogram
  • fragmented QRS complex
  • mortality
  • noninvasive risk stratification


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