Objective: To analyze the significance of detecting fragmented QRS complex (fQRS) and high-sensitivity cardiac troponin T (hs cTnT) in patients with acute anterior wall myocardial infarction (AAMI) on electrocardiogram. Methods: A total of 106 AAMI patients admitted to Zhaoling District People"s Hospital from January 2023 to January 2025 were retrospectively selected and divided into a good prognosis group and a poor prognosis group based on their prognosis. The general information of the two groups of patients was compared, including electrocardiogram indicators (fQRS proportion, left ventricular ejection fraction (LVEF), left ventricular end diastolic diameter (LVEDD)), biochemical indicators (hs cTnT, N-terminal pro brain natriuretic peptide (NT proBNP), C-reactive protein (CRP), D-dimer (D-D)), and the association between electrocardiogram indicators, biochemical indicators and poor prognosis in AAMI patients was analyzed using multivariate logistic regression. Results: During a follow-up period of at least 6-10 months, a total of 41 cases (38.68%) of AAMI patients were classified as poor prognosis group. Compared with the good prognosis group, the poor prognosis group had significantly higher fQRS proportion, LVEDD, hs cTnT, NT proBNP levels, and significantly lower LVEF levels (P<0.05). However, there was no statistically significant difference in CRP and D-D levels between the two groups of patients (P>0.05). Multivariate logistic regression analysis also confirmed that fQRS proportion and hs cTnT levels were independent influencing factors for poor prognosis in AAMI patients (P<0.05). Conclusion: fQRS and hs cTnT on electrocardiogram are both factors affecting poor prognosis in AAMI patients, and clinical attention should be closely monitored to take timely measures to improve patient prognosis.