What question did this study set out to answer?

The study aims to evaluate if new EKG changes can predict the need for acute coronary interventions like PCI and CABG.

January 10, 2026BMC Cardiovascular Disorders0 citationsOpen Access

New electrocardiographic changes as predictors of acute coronary interventions in the emergency department: a retrospective observational study

KHKatherine A. HolmesJPS Health Network EDEmily DroneJPS Health Network KLKaitlyn LizardoJPS Health Network

Key Result

New EKG changes strongly predict the need for PCI/CABG, offering prognostic value that exceeds traditional HEART scoring in the emergency department.

Key Points

The study aims to evaluate if new EKG changes can predict the need for acute coronary interventions like PCI and CABG.
Retrospective observational design
Analysis of EKG changes in patients in the emergency department
Assessment of traditional HEART scoring alongside new EKG findings
New EKG changes were strongly associated with the need for PCI or CABG
Traditional HEART scoring was found to underestimate the risk for some patients
Prognostic value of new EKG changes exceeds that of static EKG interpretations

Structured PICO

Does the presence of new serial EKG changes predict the requirement for PCI or CABG in emergency department patients presenting with chest pain?

Population

1,862 adult patients presenting to the emergency department at least twice between January 1, 2019, and December 31, 2023, with chest pain or equivalent symptoms suggestive of acute coronary syndrome, who had HEART scores calculated and at least one EKG performed during each ED visit. Excluded: STEMI on index visit, <18 years of age, pregnant patients, incarcerated individuals, and non-cardiac chest pain.

Intervention

Presence of new EKG changes between serial ED visits or during the ED stay, categorized into new common ischemic patterns (T-wave inversions, ST-T segment depressions), pseudo-normalization, or new uncommon ischemic patterns (QT prolongation, U-waves, LBBB, hyperacute T-waves).

Comparator

Absence of new EKG changes (static EKG findings across serial evaluations).

Outcome

Requirement for urgent/emergent cardiac interventions (percutaneous coronary intervention [PCI] or coronary artery bypass grafting [CABG]).hard clinical

Integrating serial EKG changes into the HEART score significantly improves the identification of ED patients with chest pain who require urgent PCI or CABG.

Main Result

Absolute Event Rate: 0% vs 0%

Abstract

New EKG changes may be strongly associated with the need for PCI/CABG and provide prognostic value beyond static EKG interpretation. Relying solely on traditional HEART scoring may underestimate risk in a significant subset of patients.

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