Key result
Fragmented QRS linked to ~130% higher CAD risk in angina patients with normal ECGs.
Why the study?
Patients with symptoms of CAD often have normal or nonspecific ECGs, and predictors of CAD in this scenario are not well defined.
Do fragmented QRS, elevated CK-MB, and male sex predict coronary artery disease in patients with angina and normal ECGs?
Observational (n=142)
No
Do fragmented QRS, elevated CK-MB, and male sex predict coronary artery disease in patients with angina and normal ECGs?
Odds Ratio: 2.306 (95% CI 0.988–5.382)
Absolute Event Rate: 38.6% vs 21.6%
p-value: p=0.053
Male sex, elevated CK-MB (>10 U/L), and fragmented QRS complexes are significant predictors of coronary artery disease in patients presenting with angina and normal ECGs.
May inform noninvasive CAD risk stratification in angina with normal ECGs; leaves open prospective validation before clinical use.
Background/Aims: Patients with symptoms of coronary artery disease (CAD) often display normal tracings or only nonspecific changes on electrocardiography (ECG).The aim of this study was to explore strategic elements of the ECG and other potential factors that are predictive of CAD in this scenario.Methods: This was an observational study of 142 patients with the chief complaint of chest pain, each of whom presented with a normal ECG and was subjected to emergency coronary angiography (CAG).Two population subsets were identified: those patients (n = 97) with no significant stenotic lesions and those (n = 45) with the significant stenotic lesions of CAD.Results: Those patients with normal or nonspecific ECGs and CAD (15.8%) were more likely to have left circumflex artery involvement (20% vs. 7%).In patients with normal ECGs and CAD (vs.normal CAG), male sex (86.7% vs. 68%, p = 0.023), creatine kinase-MB (CK-MB) levels > 10 U/L (13 vs. 10, p = 0.025), and fragmented QRS (fQRS) (38.6% vs. 21.6%,p = 0.042) occurred with greater frequency.In multivariable analysis, the following variables were significant predictors of CAD, given a normal ECG: male sex (odds ratio [OR], 2.593; 95% confidence interval [CI], 1.068 to 5.839); CK-MB (OR, 2.497; 95% CI, 0.955 to 7.039); and W-or M-shaped QRS complex (OR, 2.306; 95% CI 0.988 to 5.382).Conclusions: In our view, male sex, elevated CK-MB (> 10 U/L), and fQRS complexes are suspects for CAD in patients with angina and unremarkable ECGs and should be considered screening tests.
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Lee et al. (2017) conducted an observational in Angina with normal or nonspecific ECG (n=142). Fragmented QRS (fQRS) vs. Absence of fragmented QRS was evaluated on Coronary artery disease (≥70% stenosis on angiography) (OR 2.306, 95% CI 0.988-5.382, p=0.053). Fragmented QRS complexes (OR 2.306), abnormal CK-MB (OR 2.497), and male sex (OR 2.593) were identified as predictors of coronary artery disease in patients presenting with angina and normal electrocardiograms.
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