The Relationship Between fragmented QRS Complexes (fQRS) and the Severity of Coronary Artery Lesion in Coronary Artery Disease: A Cross-sectional Study

Ika Prasetya Wijaya, Eka Ginanjar, Andhika Rachman, M Hafiz Aini


Background: The severity of coronary artery lesion is commonly used as a predictor of mortality, major adverse cardiovascular event, and revascularization in coronary artery disease (CAD). Fragmented QRS complex (fQRS) is used as a marker of myocardial ischemia in patients with CAD. The relationship between the two should be studied further. The objective of this study was to determine the relationship between fQRS and the severity of coronary lesion in patients with CAD. Methods: A cross-sectional study was conducted at Cipto Mangunkusumo Hospital Jakarta. Secondary data were taken from 172 patients with CAD who underwent percutaneous coronary intervention (PCI) from January to June 2018 with total sampling. Patients were divided into two groups based on the existence of fQRS. Demographic, clinical, and corangiography characteristics (Gensini score, total vascular lesion, and vascular lesion significance) were studied. Data were analyzed using agreement test and chi-square. Results: fQRS was present in 94 subjects (54.6%). Bivariate analysis showed a significant difference between fQRS with mild-moderate Gensini score as well as mild-severe Gensini score (kappa = 0.721 and 0.820; p<0.001), fQRS with significant CAD (kappa = 0.670; p<0.001), and fQRS with multivessel CAD (kappa = 0.787; p<0.001). Conclusion: There is a significant relationship between fQRS and the degree of severity of coronary lesion in CAD patients.


coronary artery disease; fragmented QRS; Gensini score


WHO. What are the risk factors for cardiovascular disease? What are common symptoms of cardiovascular diseases? [Internet]. Fact sheet N°317. 2015 [cited 2017 Nov 12]. Available from:

Neeland IJ, Patel RS, Eshtehardi P, et al. Coronary angiographic scoring systems: an evaluation of their equivalence and validity. Am Hear J. 2012;164(4):547–52.

Gensini GG. A more meaningful scoring system for determining the severity of coronary heart disease. Am J Cardiol. 1983;51(3):606.

Sinning C, Lillpopp L, Appelbaum S, et al. Angiographic score assessment improves cardiovascular risk prediction: the clinical value of SYNTAX and Gensini application. Clin Res Cardiol. 2013;102(7):495–503.

Das MK, Khan B, Jacob S, Kumar A, Mahenthiran J. Significance of a fragmented QRS complex versus a Q wave in patients with coronary artery disease. Circulation. 2006;113(21):2495–501.

Varriale P, Chryssos BE. The RSR′ complex not related to right bundle branch block: diagnostic value as a sign of myocardial infarction scar. Am Hear J. 1992;123(2):369–76.

El-Dosouky II, Abomandour HG. Fragmented QRS complex as a predictor of coronary artery disease in patients with acute coronary syndrome: a study from Egypt. Indian Hear J. 2017;69(2):289–90.

Ishikawa K, Shimizu M, Ohno M, et al. Clinical significance of abnormal Q wave disappearance in acute transmural myocardial infarction. Circ J. 1991;55:213–20.

Das MK, Suradi H, Maskoun W, et al. Fragmented wide QRS on a 12-lead ECG: a sign of myocardial scar and poor prognosis. Circ Arrhythmia Electrophysiol. 2008;1(4):258–68.

Oberman A, Jones WB, Riley CP, Reeves TJ, Sheffield LT. Natural history of coronary artery disease. Bull N Y Acad Med. 1972;48(9):1109–25.

Sen F, Yilmaz S, Kuyumcu MS, Özeke Ö, Balci MM, Aydogdu S. The presence of fragmented QRS on 12-lead ECG in patients with coronary artery ectasia. Korean Circ J. 2014;72(1):14–9.

Bekler A, Barutçu A, Tenekecioglu E, et al. The relationship between fragmented QRS complexes and SYNTAX and Gensini scores in patients with acute coronary syndrome. Kardiol Pol. 2015;73(4):246–54.

Rahman HA, Ghany MA, Youssef AAA. Correlation of fragmented QRS complexes with the severity of CAD (using Syntax score) in patients with non-ST elevation acute coronary syndromes. Egypt Hear J. 2016;68(2):125–9.

Aepfelbacher FC, Johnson RB, Schwartz JG, et al. Validation of a model of left ventricular segmentation for interpretation of SPET myocardial perfusion images. Eur J Nucl Med. 2001;28(11).

Caliskan B, Korkmaz AN, Erdem F. Contribution of fragmented QRS on myocardial perfusion imaging in the assessment of functionally significant coronary artery stenoses. Eur Rev Med Pharmacol Sci. 2016;20(8):1575–81.

Ozdemir S, Tan YZ, Colkesen Y, Temiz A, Turker F, Akgoz S. Comparison of fragmented QRS and myocardial perfusion-gated SPECT findings. Nucl Med Commun. 2013;34(11):1107–15.

Kocaman SA, Çetin M, Kiriş T, et al. The importance of fragmented QRS complexes in prediction of myocardial infarction and reperfusion parameters in patients undergoing primary percutaneous coronary intervention. Arch Turk Soc Cardiol. 2012;40(3):213–22.

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