QRS Complex Fragmentation as a Marker of In-Hospital Mortality and Adverse Long-Term Prognosis in Patients with ST-Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention: A Systematic Review and Meta-Analysis
R.S. Ilchenko, A.Yu. Zakirzyanov, V.A. Kokorin, A.Yu. Lebedeva, I.G. Gordeev
Background. QRS complex fragmentation (fQRS) is regarded as an electrocardiographic marker of inhomogeneous intraventricular conduction that may reflect ischemic injury, scar formation, and myocardial electrical instability. In patients with ST-elevation myocardial infarction (STEMI) undergoing percutaneous coronary intervention (PCI), the presence of fQRS may be associated with an increased risk of early and long-term adverse cardiovascular outcomes.
Objective: To evaluate the prognostic value of fQRS in patients with STEMI who underwent PCI with respect to in-hospital mortality and major adverse cardiovascular events during long-term follow-up.
Materials and methods. A systematic search was conducted in the PubMed and Cochrane Library databases covering the period from January 1, 2010, to May 1, 2026. Prospective and retrospective observational studies of STEMI patients who underwent primary PCI were included if they reported data on in-hospital mortality and/or long-term adverse cardiovascular outcomes stratified by fQRS status. The quality of included studies was assessed using the Newcastle–Ottawa Scale. Quantitative synthesis was performed using a random-effects model to calculate the pooled odds ratio (OR) for in-hospital mortality and risk ratio (RR) for long-term outcomes. Heterogeneity was assessed using the I² statistic; the robustness of the findings was assessed by sequential leave-one-out sensitivity analysis.
Results. Nine studies comprising a total of 3,834 patients were included in the analysis. The presence of QRS complex fragmentation on ECG was associated with an increased risk of in-hospital mortality (OR 3.15; 95% CI: 1.70–5.84; p = 0.0003; I² = 65%) and adverse long-term cardiovascular outcomes (RR 3.43; 95% CI: 1.78–6.61; p = 0.0002; I² = 61%) in STEMI patients after primary PCI. Following exclusion of two outlier studies, heterogeneity for the in-hospital mortality outcome decreased (I² = 27%) while the statistical significance of the effect was maintained.
Conclusion. The results of this meta-analysis indicate an association between QRS complex fragmentation and an increased risk of in-hospital mortality and adverse long-term cardiovascular outcomes in STEMI patients who underwent primary PCI. However, the heterogeneity of results and the predominantly observational nature of the included studies necessitate cautious interpretation of the findings. Further prospective studies are warranted to clarify the prognostic value of fQRS.
For citation: Ilchenko RS, Zakirzyanov AYu, Kokorin VA, Lebedeva AYu, Gordeev IG. QRS complex fragmentation as a marker of in-hospital mortality and adverse long-term prognosis in patients with ST-elevation myocardial infarction undergoing primary percutaneous coronary intervention: A systematic review and meta-analysis. Therapy (Moscow). 2026;12(5S):86–93.
https://doi.org/10.18565/ therapy.2026.5-s5.86-93
Ключевые слова
QRS complex fragmentation
myocardial infarction
prognosis
electrocardiography
meta-analysis
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Об авторах / Для корреспонденции
Roman S. Ilchenko, MD, senior laboratory assistant at the Department of hospital therapy named after academician P.E. Lukomsky, Pirogov Russian National Research Medical University, Moscow, Russian Federation.E-mail: ilchenkoroman@hotmail.com
ORCID: https://orcid.org/0000-0003-3141-6888. Scopus ID: 57209736154. eLibrary SPIN: 1746-6671
Artem Yu. Zakirzyanov, MD, anesthesiologist-intensivist of the Intensive Care Unit, Moscow Multidisciplinary Clinical Center “Kommunarka”, Moscow, Russian Federation.
E-mail: artemwispaartem@yandex.ru
ORCID: https://orcid.org/0009-0009-3612-4623
Valentin A. Kokorin, MD, Dr. Sci. (Medicine), professor, head of the Department of hospital therapy with courses in endocrinology, hematology, and clinical laboratory diagnostics, RUDN University; professor of the Department of hospital therapy named after academician P.E. Lukomsky, Pirogov Russian National Research Medical University, Moscow, Russian Federation.
E-mail: kokorin-va@rudn.ru
ORCID: https://orcid.org/0000-0001-8614-6542. Scopus ID: 60478883000. eLibrary SPIN: 9772-2288
Nikolay A. Volov, MD, PhD (Medicine), associate professor of the Department of hospital therapy named after academician P.E. Lukomsky, Pirogov Russian National Research Medical University, Moscow, Russian Federation.
E-mail: drvolov@yandex.ru
ORCID: https://orcid.org/0000-0001-6894-6028. Scopus ID: 6602417780
Anastasia Yu. Lebedeva, MD, Dr. Sci. (Medicine), professor, head of the Regional Vascular Center, Moscow Multidisciplinary Clinical Center “Kommunarka”; head of the Department of interventional cardiology and cardiac rehabilitation, Pirogov Russian National Research Medical University, Moscow, Russian Federation.
E-mail: alebedeva-md@yandex.ru
ORCID: https://orcid.org/0000-0002-4060-0786. Scopus ID: 56300028500. eLibrary SPIN: 5700-5075
Ivan G. Gordeev, MD, Dr. Sci. (Med.), professor, deputy director of the Institute of Clinical Medicine, head of the Department of hospital therapy named after academician P.E. Lukomsky, Pirogov Russian National Research Medical University, Moscow, Russian Federation.
E-mail: cardio-15@yandex.ru
ORCID: https://orcid.org/0000-0002-4007-9679. Scopus ID: 6603979981
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