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European Heart Journal Advance Access published online on December 7, 2005
European Heart Journal, doi:10.1093/eurheartj/ehi683
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European Heart Journal © The European Society of Cardiology 2005; all rights reserved
Received May 16, 2005
Revised November 12, 2005
Accepted November 24, 2005

Clinical research

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

Axel Bauer 1, Mari A. Watanabe 2, Petra Barthel 1, Raphael Schneider 1, Kurt Ulm 3, and Georg Schmidt 1 *

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

* To whom correspondence should be addressed.
Georg Schmidt, E-mail: gschmidt{at}tum.de


  Abstract

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.

Keywords: Bundle-branch block; Sudden death; Electrocardiography; Mortality; Myocardial infarction; Prognosis; QRS duration.
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