An abnormal presenting electrocardiogram in patients with non-ST elevation acute coronary syndrome was significantly associated with severe coronary artery disease on angiography (OR 3.68).
Cohort (n=198)
No
Does the presenting 12-lead ECG correlate with coronary angiography findings and severity of CAD in patients with NST-ACS?
Abnormal admission ECG, particularly ST depression and T-wave inversion, is significantly associated with severe CAD on angiography in patients with NST-ACS, supporting its use for early risk stratification and triage.
Effect estimate: OR 3.68 (95% CI 1.23-11.04)
Absolute Event Rate: 35.3% vs 12.9%
p-value: p=0.0141
Background: Clinical guidelines recommend risk stratification of non-ST elevation acute coronary syndrome (NST-ACS) using the GRACE risk score. However, the GRACE risk score is not followed widely in clinical practice due to various reasons. Our primary objectives of this study were to correlate the presenting electrocardiogram (ECG) of NST-ACS with coronary angiography (CAG) findings and to identify specific ECG changes that are suggestive of severe coronary artery disease (CAD) thus helping to triage all patients with NST-ACS. Materials and Methods: This prospective observational study was undertaken on patients diagnosed with NST-ACS in a medical college hospital, in Northern India over one and a ½ years. The admission ECG of the patients was compared with CAG findings to find out the correlation between the two with respect to severity of CAD. Categorical and quantitative variables were compared using the Chi-square test and independent t-test, respectively. Odds ratio (OR) were calculated using the univariate logistic regression analysis. Results: On comparing the two groups with normal and abnormal ECG, we found that smokers had significantly higher odds of having an abnormal ECG (OR 3.31; 95% confidence interval CI 1.29-8.50). Patients with an abnormal ECG had significantly lower left ventricular ejection fraction compared to those with normal ECG (52.01 ± 10.56 vs. 55.96 ± 6.13%, P = 0.045). The patients with severe CAD on CAG had significantly higher odds of abnormal ECG (OR 3.68, 95% CI 1.2311.04). Of the specific ECG abnormalities, ST depression and T-wave inversion in same or different leads were significantly associated with severity of CAD (OR 0.13, 95% CI 0.04-0.43, P = 0.001 and OR 0.13, 95% CI 0.03-0.46, P = 0.002, respectively). Conclusion: The identification of ECG changes suggestive of high-risk CAD can dictate to transfer such patients without delay to a percutaneous coronary intervention capable hospital for urgent CAG with intent to revascularization, thus helping in risk stratification of NST-ACS at the community level.
Kumar et al. (Fri,) conducted a cohort in Non-ST elevation acute coronary syndrome (NST-ACS) (n=198). Abnormal ECG vs. Normal ECG was evaluated on Severe coronary artery disease on coronary angiography (OR 3.68, 95% CI 1.23-11.04, p=0.0141). An abnormal presenting electrocardiogram in patients with non-ST elevation acute coronary syndrome was significantly associated with severe coronary artery disease on angiography (OR 3.68).