Diagnostic and prognostic value of regional wall motion abnormalities in patients with non-ST-elevation myocardial infarction

Background Beyond global left ventricular function, identification of regional wall motion abnormalities (RWMA) is an essential component of emergency echocardiography in patients with non-ST-elevation myocardial infarction (NSTEMI). This study investigated the prognostic significance and diagnostic value of RWMA. Methods Echocardiographies of 1110 consecutive NSTEMI patients undergoing coronary angiography were analyzed. Patients were classified as type 1 NSTEMI if an atherosclerotic culprit lesion was identified, otherwise as type 2. Adverse in-hospital events were a composite of in-hospital death, cardiogenic shock, and mechanical ventilation. Results Among 895 patients with type 1 NSTEMI and 215 with type 2, RWMA were present in 68.2% overall. Adverse in-hospital events occurred in 18.1% of patients with RWMA versus 10.5% without (OR 1.89, 95% CI 1.29–2.81). Mediation analysis showed this excess risk was largely attributable to reduced ejection fraction. RWMA occurred more frequently in type 1 compared with type 2 NSTEMI (70.3% vs. 59.5%, p = 0.003) and remained an independent predictor of type 1 NSTEMI (OR 1.69, p = 0.002). However, the diagnostic accuracy of RWMA alone was modest (AUC 0.554), improving to fair performance (AUC 0.727) when combined with clinical factors. Among type 1 NSTEMI patients, RWMA corresponded to the culprit lesion territory in 90.1% when present. Conclusions RWMA identify NSTEMI patients at higher risk of adverse outcomes. Although insufficient alone to differentiate type 1 from type 2 NSTEMI, RWMA augment diagnostic accuracy when combined with clinical factors. Routine RWMA assessment during emergency evaluation may help guide the urgency of invasive management and anticipate the culprit lesion location.