ABSTRACT
OBJECTIVES: There are studies in the literature showing the clinical importance of fragmented QRS (fQRS) in many systemic diseases. In this study, we aimed to investigate the frequency and prognostic value of fQRS on electrocardiogram (ECG) in patients with acute ischemic stroke. MATERIALS AND METHODS: We prospectively enrolled 241 patients with acute ischemic stroke between January 2018 and January 2020. ST depression and elevation, QRS duration, PR interval, RR interval, QTc interval, QTc dispersion (QTcd), T negativity, Q wave, and fQRS were evaluated on ECG. Brain computed tomography (CT) and diffusion magnetic resonance imaging (MRI) images were obtained in the acute period and the National Institute of Health Stroke Scale (NIHSS) score was calculated for each patient. Patients were followed up for a period of two years. RESULTS: The 241 patients comprised 121 (50.2%) men and 120 (49.8%) women with a mean age of 67.52 ± 13.00 years. In Cox regression analysis, age, NIHSS, QTcd, and fQRS were found to be independent predictors of mortality (age, hazard ratio [HR]: 1.063, p < 0.001; NIHSS, HR: 1.116, p = 0.006; QTcd, HR: 1.029, p = 0.042; fQRS, HR: 2.048, p = 0.037). Two-year mortality was higher in patients with fQRS than in patients without fQRS (31% vs. 9%, p = 0.001). CONCLUSIONS: The fQRS is associated with poor prognosis in patients with acute ischemic stroke.
Subject(s)
Action Potentials , Arrhythmias, Cardiac/diagnosis , Electrocardiography , Heart Conduction System/physiopathology , Heart Rate , Ischemic Stroke/complications , Aged , Aged, 80 and over , Arrhythmias, Cardiac/etiology , Arrhythmias, Cardiac/mortality , Arrhythmias, Cardiac/physiopathology , Diffusion Magnetic Resonance Imaging , Female , Humans , Ischemic Stroke/diagnostic imaging , Ischemic Stroke/mortality , Male , Middle Aged , Predictive Value of Tests , Prognosis , Retrospective Studies , Risk Assessment , Risk Factors , Time Factors , Tomography, X-Ray ComputedABSTRACT
OBJECTIVE: Lifelong statin treatment is recommended in patients with cardiovascular diseases, but drug adherence is a significant problem. The aim of this study was to investigate factors related to statin discontinuation in high-risk patients with coronary artery disease (CAD) diagnosed by coronary angiography. METHODS: A total of 300 consecutive patients who were followed-up with a diagnosis of CAD were recruited. Patients were categorized as statin adherent or statin non-adherent (patients interrupting statin therapy >30 days). Study participants completed a questionnaire regarding demographic characteristics, medical history, knowledge of statin treatment, and factors related to statin discontinuation. RESULTS: In all, 160 patients (53.3%) were found to be statin adherent. Of those, 122 patients had suffered myocardial infarction, and atorvastatin was the most prescribed statin on discharge. Among the study population, 26% were illiterate and 55% had graduated from primary school. Only 39 cases (13%) cases had a low-density lipoprotein-cholesterol level <70 mg/dL. In 60% of the statin non-adherent patients, the reason for statin discontinuation was physician discontinuation of the statin prescription. In 14%, the patient stopped the therapy after cholesterol parameters had been reduced or reached the normal range. Only 8% of participants reported that negative information received from TV programs and social media was responsible for the decision to terminate drug use. CONCLUSION: Our findings demonstrated that the importance of intensive statin treatment in CAD patients has not been recognized by patients or many physicians. Adherence to statin treatment and success of the therapy is low, leading to unnecessarily high cholesterol levels in patients with CAD.
