Comparative Analysis of Ischemic Changes in Electrocardiography and Coronary Artery Angiography as Gold Standard

Q: What is the clinical evidence from this study?

Study design: Cross-Sectional. Population: Suspected myocardial ischemia / Coronary artery disease (n=169). Intervention: ST-T ischemic changes on Electrocardiography (ECG) vs. Coronary artery angiography (CAG) as reference gold standard. Primary outcome: Diagnostic accuracy of ST-T ischemic changes on ECG for detecting coronary artery disease compared with CAG.

Umar Farooq; Dr. Sheeraz Ahmed; Dr. Muhammad Aslam Shad

doi:10.56810/jpbm.004.04.0271

October 12, 2026Journal of Pharma and BiomedicsOpen Access

Comparative Analysis of Ischemic Changes in Electrocardiography and Coronary Artery Angiography as Gold Standard

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Key result

Ischemic ST-T changes detect CAD with ~82% diagnostic accuracy compared to coronary angiography.

n=169

Why the study?

Coronary angiography is invasive and costly for diagnosing coronary artery disease, whereas the electrocardiogram is cheap, safe, and widely available, yet its diagnostic performance varies across populations.

Does 6-lead or 12-lead ECG evaluating ST-T ischemic changes accurately detect coronary artery disease compared to invasive coronary angiography in adult patients presenting with prolonged chest pain or ischemic ECG changes?

Key Points

To evaluate the diagnostic accuracy of ST-T ischemic changes on electrocardiography compared with coronary artery angiography, including vessel-level and sex-specific performance.
Cross-sectional study of 169 adult patients with chest pain who showed ST-T ischemic changes on ECG and underwent coronary angiography within 1 to 3 days at a single center in Peshawar, Pakistan.
Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and diagnostic accuracy were determined overall and across the LAD, RCA, and LCX arteries, with subgroup analyses by sex.
Compared with coronary angiography, electrocardiography demonstrated a sensitivity of 83.3%, specificity of 72.0%, PPV of 94.5%, NPV of 42.8%, and overall accuracy of 81.7%.
Vessel-level diagnostic accuracy was 82.0% for the RCA, 79.1% for the LAD, and 76.8% for the LCX, with PPV exceeding 90% across all three vessels.
Specificity was significantly higher in men than in women for the RCA (90.9% vs 80.0%, P = 0.010) and LCX (83.3% vs 72.7%, P = 0.036), whereas sensitivity, PPV, NPV, and accuracy showed no significant sex differences.

Study Design

Type

Cross-Sectional (n=169)

Multicenter

No

Structured PICO

Does 6-lead or 12-lead ECG evaluating ST-T ischemic changes accurately detect coronary artery disease compared to invasive coronary angiography in adult patients presenting with prolonged chest pain or ischemic ECG changes?

P

Population

169 adults aged 30 to 85 years (38.5% female) with prolonged chest pain or ST-T ischemic changes on ECG undergoing invasive coronary angiography within 1 to 3 days at a tertiary hospital in Pakistan.

E

Exposure

6-lead or 12-lead electrocardiography (ECG) evaluating ST-segment and T-wave (ST-T) ischemic changes

C

Comparator

Invasive coronary angiography (CAG) performed within 1 to 3 days under standard protocol as the reference gold standard

O

Outcome

Overall diagnostic performance (sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy) of ST-T ischemic changes on ECG for detecting coronary artery disease against CAG as the reference standardsurrogate

ST-T ischemic changes on ECG demonstrate good sensitivity (83.3%) and high positive predictive value (94.5%) for detecting coronary artery disease in high-risk symptomatic patients, but a low negative predictive value (42.8%) means a negative ECG cannot safely rule out obstructive disease.

Limitations

Single-center study with non-probability convenience sampling
Retrospective analysis of ECG and CAG reports
Selection and verification bias as only patients with ST-T changes or prolonged chest pain referred for angiography were included
High disease prevalence (85.2%) inflated positive predictive value and deflated negative predictive value
Small sample size for female subgroup (n = 65) and certain individual risk factors
Potential confounding from silent ischemia and non-coronary ECG abnormalities
Conducted at a single centre with non-probability convenience sampling
ECG and CAG reports were analysed retrospectively
Only patients who already had ST-T changes or prolonged chest pain and were referred for angiography were included, introducing selection and verification bias and preventing estimation of ECG performance in the general population
Silent ischemia and ECG abnormalities from non-coronary causes may have affected the agreement between ECG and anatomical findings
Sample size for some individual risk factors and the female subgroup (n = 65) was small, and multiple comparisons were made without adjustment for multiple testing

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Implication

ECG may aid CAD detection where angiography is limited; leaves open prospective validation before clinical adoption.

Abstract

Background: Ischemic heart disease (IHD) is a leading cause of death worldwide. Coronary angiography (CAG) is the gold standard for diagnosing coronary artery disease, but it is invasive and costly. The electrocardiogram (ECG) is cheap, safe and widely available, yet its diagnostic performance varies across populations. This study evaluated the diagnostic accuracy of ST-T ischemic changes on ECG against CAG and examined vessel-level and sex-specific performance. Methods: This cross-sectional study included 169 adult patients with chest pain who showed ST-T ischemic changes on ECG and underwent CAG within 1 to 3 days at North West General Hospital and Research Centre, Peshawar, Pakistan. Sensitivity, specificity, positive and negative predictive values (PPV, NPV) and diagnostic accuracy were calculated with CAG as the reference standard, overall and for the left anterior descending (LAD), right coronary (RCA), and left circumflex (LCX) arteries. Performance was compared between men and women. Results: The cohort comprised 104 men (61.5%) and 65 women (38.5%) aged 30 to 85 years. Hypertension (72.7%) and diabetes mellitus (40.8%) were the most frequent risk factors. ECG was positive in 75.1% and CAG in 85.2% of patients, with no significant difference by sex or age. Compared with CAG, ECG achieved a sensitivity of 83.3%, specificity of 72.0%, PPV of 94.5%, NPV of 42.8% and accuracy of 81.7%. Vessel-level accuracy was 82.0% for the RCA, 79.1% for the LAD and 76.8% for the LCX. Specificity was higher in men than in women for the RCA (90.9% vs 80.0%, P = 0.010) and LCX (83.3% vs 72.7%, P = 0.036); other metrics did not differ significantly. Conclusion: ST-T ischemic changes on ECG have good sensitivity and a high positive predictive value but only moderate specificity and a low negative predictive value for coronary artery disease. ECG is a useful first-line, non-invasive indicator, but a negative tracing cannot exclude coronary disease, and CAG remains necessary for definitive anatomical assessment.

Discussion

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Cite This Study

Farooq et al. (2026) conducted a cross-sectional in Suspected myocardial ischemia / Coronary artery disease (n=169). ST-T ischemic changes on Electrocardiography (ECG) vs. Coronary artery angiography (CAG) as reference gold standard was evaluated on Diagnostic accuracy of ST-T ischemic changes on ECG for detecting coronary artery disease compared with CAG. ST-T ischemic changes on ECG achieved 81.7% diagnostic accuracy, 83.3% sensitivity, 72.0% specificity, 94.5% PPV, and 42.8% NPV for detecting coronary artery disease compared to coronary angiography.

synapsesocial.com/papers/6ae28e56cbadf70daf6c41c8 https://doi.org/10.56810/jpbm.004.04.0271

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Comparative Analysis of Ischemic Changes in Electrocardiography and Coronary Artery Angiography as Gold Standard

Key Points

Study Design

Structured PICO

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Comparative Analysis of Ischemic Changes in Electrocardiography and Coronary Artery Angiography as Gold Standard

Key Points

Study Design

Structured PICO

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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