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April 28, 2026Journal of Cardiothoracic Surgery0 citationsOpen Access

The effectiveness of right-sided electrocardiogram in non-ST-segment elevation myocardial infarction

MŞMuhammed İkbal ŞaşmazMUMustafa UcarDBDoğuhan Bitlisli

Key Result

Right-sided ECG ischemic findings in NSTEMI patients were associated with significantly higher mean SYNTAX scores compared to patients without ischemic findings (19.41 vs 11.59).

Key Points

  • The study aims to assess how effectively right-sided ECG can identify right ventricular ischemia in NSTEMI patients.
  • Prospective, single-center trial including 114 NSTEMI patients.
  • Standard and right-sided ECGs were obtained and evaluated for ischemic findings.
  • Comparative analysis of SYNTAX scores and 1-month MACE rates between groups.
  • 40 patients (35.1%) exhibited ischemic findings on right-sided ECG.
  • 5 patients (4.4%) had ST elevation in V3R–V5R leads, indicating right ventricular myocardial infarction.
  • Mean SYNTAX score was significantly higher in patients with ischemic findings (27.3 ± 10.83) versus those without (11.59 ± 8.88; p < 0.001).

Study Design

Type

Observational (n=114)

Multicenter

No

Structured PICO

Does the presence of ischemic findings on right-sided ECG identify higher SYNTAX scores and worse 1-month MACE rates in patients with NSTEMI?

P
Population
114 patients with non-ST-segment elevation myocardial infarction (NSTEMI), mean age 64.04, 62.3% male, single-center in Turkey. Exclusions: hemodynamic instability, ST elevation during follow-up, posterior MI findings, Wellen pattern on standard ECG, non-ACS causes of elevated troponin, pregnant patients, and widespread ST depression and ST elevation in aVR suggesting a left main coronary lesion.
I
Intervention
Right-sided electrocardiogram (ECG) evaluating for ischemic findings (ST segment elevation > 1 mm in V3R-V5R leads, ST segment depression > 0.5 mm, or T wave inversion > 1 mm).
C
Comparator
NSTEMI patients without ischemic findings on right-sided ECG.
O
Outcome
SYNTAX scores and 1-month major cardiac adverse event (MACE) rates.composite

Ischemic findings on right-sided ECG in NSTEMI patients correlate with more complex coronary artery disease (higher SYNTAX scores), suggesting a potential role for right-sided ECG to identify patients who may benefit from early angiography.

Main Result

Absolute Event Rate: 19.41% vs 11.59%

p-value: p=<0.001

Limitations

  • Right-sided ECGs were not always obtained simultaneously with the initial standard ECGs, often after antiplatelet/anticoagulant therapy was given
  • Short follow-up period of 1 month for major adverse cardiac events (MACE)
  • Potential confounders such as pre-existing comorbidities and medication use were not fully adjusted for in the analysis
  • Low prevalence of right ventricular MI in the cohort limited statistical power to detect differences in clinical outcomes
  • Right-sided ECGs were not always obtained simultaneously with the initial standard ECGs (patients had already received antiplatelet and anticoagulant therapy)
  • Short follow-up period (1-month MACE)
  • Potential confounders such as pre-existing comorbidities and medication use were not fully adjusted for
  • Low prevalence of right ventricular MI in the cohort (small sample size limited statistical power)

Abstract

This study aims to evaluate the effectiveness of right-sided ECG in identifying RV ischemia or infarction in NSTEMI patients and to compare the SYNTAX scores and 1-month major cardiac adverse event (MACE) rates between patients with and without ischemic findings on right-sided ECG. This prospective, single-center study included 114 NSTEMI patients. Standard and right-sided ECGs were obtained, and ischemic findings were evaluated. The presence of ST elevation in the V3R-V5R leads on the right-sided ECG was used to diagnose right ventricular myocardial infarction. SYNTAX scores and 1-month MACE rates were compared between patients with and without ischemic findings on right-sided ECG. A total of 40 patients (35.1%) demonstrated ischemic findings on the right-sided ECG. Five patients (4.4%) showed ST elevation in the V3R–V5R leads, suggesting right ventricular myocardial infarction. The mean SYNTAX score in patients with ischemic findings on right-sided ECG was significantly higher (27.3 ± 10.83) compared to those without ischemic findings (11.59 ± 8.88; p < 0.001). This study demonstrates the potential benefit of right-sided ECG in diagnosing right ventricular infarction or ischemia in NSTEMI patients, which may facilitate early angiography and improve prognosis.

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Cite This Study

Şaşmaz et al. (2026) conducted an observational in Non-ST-segment elevation myocardial infarction (NSTEMI) (n=114). Right-sided electrocardiogram (ECG) vs. Patients without ischemic findings on right-sided ECG was evaluated on SYNTAX score (p=<0.001). Right-sided ECG ischemic findings in NSTEMI patients were associated with significantly higher mean SYNTAX scores compared to patients without ischemic findings (19.41 vs 11.59).

synapsesocial.com/papers/69f04e9b727298f751e7280ehttps://doi.org/10.1186/s13019-026-04183-w
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