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European Heart Journal Advance Access originally published online on December 7, 2005
European Heart Journal 2006 27(4):427-433; doi:10.1093/eurheartj/ehi683
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© The European Society of Cardiology 2005. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org

QRS duration and late mortality in unselected post-infarction patients of the revascularization era

Axel Bauer1,{dagger}, Mari A. Watanabe2,{dagger}, Petra Barthel1, Raphael Schneider1, Kurt Ulm3 and Georg Schmidt1,*

11. Medizinische Klinik der Technischen Universität München and Deutsches Herzzentrum München, Ismaninger Straße 22, 81675 München, Germany
2Department of Pharmacological and Physiological Science, St Louis University School of Medicine, St Louis, USA
3Institut für Medizinische Statistik und Epidemiologie der Technischen Universität München, München, Germany

Received 16 May 2005; revised 12 November 2005; accepted 24 November 2005; online publish-ahead-of-print 7 December 2005.

* Corresponding author. Tel: +49 89 4140 2352; fax: +49 89 4140 4862. E-mail address: gschmidt{at}tum.de

Aims To assess the association of prolonged QRS duration and late mortality in unselected post-infarction patients of the revascularization era.

Methods and results A total of 1455 survivors of acute myocardial infarction (MI) in sinus rhythm and under 76 years of age were enrolled. Ninety eight percent of the patients received reperfusion/revascularization therapy (90% percutaneous coronary intervention). After revascularization, prolonged QRS duration (≥120 ms) was present in 87 patients (6.0%). Additional risk factors studied were age (≥65 years), presence of diabetes mellitus, history of previous MI, mean heart rate (>75 b.p.m.), heart rate variability index (≤20 U), arrhythmia on Holter, left ventricular ejection fraction (LVEF≤30%), and heart rate turbulence (HRT). Primary endpoint was total mortality. During a follow-up period of 22±5 months, 70 patients died. On multivariable analysis, prolonged QRS duration showed the highest association with total mortality (hazard ratio 4.0; CI 2.3–6.9) followed by HRT Category 2 (3.8; 2.0–7.3) and LVEF≤30% (3.1; 1.7–5.6). The association of prolonged QRS duration and late mortality was particularly strong in patients with LVEF≤30% (5.0; 1.8–14.1). On multivariable analysis of secondary endpoints, prolonged QRS duration was significantly associated with cardiac mortality (3.9; 1.9–7.8), but not with sudden death and serious arrhythmic events.

Conclusion In the revascularization era, incidence of prolonged QRS duration is reduced. However, prolonged QRS duration is still highly correlated with increased late mortality.

Key Words: Bundle-branch block • Sudden death • Electrocardiography • Mortality • Myocardial infarction • Prognosis • QRS duration


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