Key result
Normal admission ECGs occur in ~4% of non-ST-elevation ACS hospitalizations, mostly reflecting single-vessel disease.
Why the study?
Patients with ACS and a normal ECG may face an increased risk of late diagnosis and complications.
Observational (n=3,137)
Less than 5% of hospitalized patients with NSTE-ACS present with a normal ECG, and the majority of these patients have single-vessel coronary artery disease.
Caution against relying on normal ECG to exclude NSTE-ACS; leaves open whether single-vessel predominance warrants targeted prospective validation.
Background: Patients with acute coronary syndrome (ACS) and normal electrocardiogram (ECG) may have an increased risk of late diagnosis and complications of the disease. Objective: To study the demographic, angiographic and echocardiographic characteristics of patients hospitalized for ACS in whom the ECG was normal on admission to the hospital. Methods: This retrospective study included patients who were hospitalized for ACS without ST-elevation between 2015 and 2023 and who had coronary artery disease (CAD) confirmed by coronary angiography. By further inspection of the electronic databases, patients with ACS who had a normal ECG on admission were filtered out and analyzed separately. Results: Of the total 3137 patients with suspected ACS without ST-elevation, 129 patients (4.1%) were diagnosed as having ACS with a normal ECG. In three patients a non-atherosclerotic cause for the ACS was found. A significantly higher proportion of patients had single-vessel (54.3%) compared to two-vessel (29.5%) and three-vessel (14%) CAD. In addition to a normal ECG, 5.7% of patients with single-vessel CAD and 3.5% of patients with multi-vessel CAD had normal troponin levels and normal regional LV systolic function on echocardiography. Conclusion: Less than 5% of hospitalized patients with ACS without ST-elevation had a normal ECG on admission. The majority of these patients have single-vessel CAD. In about 5% of patients with single-vessel CAD, neither elevated troponin levels nor LV asynergy are detected.
No takes yet. Share an insight, caveat, or question.
Ljubojevic et al. (2024) conducted an observational in Acute Coronary Syndrome without ST-elevation (n=3,137). Normal ECG on admission was evaluated on Proportion of patients with ACS and normal ECG. Among patients hospitalized for ACS without ST-elevation, 4.1% had a normal ECG on admission, and the majority of these patients (54.3%) had single-vessel coronary artery disease.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: