Background: Many predictors were investigated to identify higher risk anterior STEMI patients who need more aggressive treatment and closer follow up. In this study, we aimed to investigate the prognostic significance of the fragmentation of the QRS complex on the admission ECG of patients with anterior ST segment elevation myocardial infarction and undergoing thrombolytic therapy during hospital course and one month after discharge. Patients and methods: This prospective study was performed on a total of 86 patients who were presenting with anterior ST segment elevation myocardial infarction undergoing thrombolytic therapy. Divided into non-fQRS group of 43 patients and fQRS group of 43 patients. Both groups were followed up during hospital stay and one month after discharge. Results: Our study results revealed that Reperfusion was significantly less frequent in fQRS group than in non-fQRS group. Recurrent angina was significantly more frequent in fQRS group than in non-fQRS group at month-1 and overall. Additionally, Coronary intervention was significantly more frequent in fQRS group than in non-fQRS group at hospital and overall. As regarding MACE, it was significantly more frequent in fQRS group. After one month follow up, significantly less left ventricular recovery was evident as well as more left ventricular dysfunction in fQRS group. Conclusion: The occurrence of fQRS in ECGs of anterior STEMI patients suggests less frequent successful fibrinolysis, more myocardial injury and hospital events as well as inadequate left ventricular recovery after 1-month follow-up period and could have predictive value of high risk patients.