What is the clinical evidence from this study?

Study design: Observational. Population: Non-ST-segment elevation myocardial infarction (NSTEMI) (n=114). Intervention: Right-sided electrocardiogram (ECG) vs. Patients without ischemic findings on right-sided ECG. Primary outcome: SYNTAX score (p=<0.001).

What question did this study set out to answer?

The study aims to assess how effectively right-sided ECG can identify right ventricular ischemia in NSTEMI patients.

April 28, 2026Open Access

The effectiveness of right-sided electrocardiogram in non-ST-segment elevation myocardial infarction

Q: What are the key findings of this study?

Right-sided ECG ischemic findings in NSTEMI patients were associated with significantly higher mean SYNTAX scores compared to patients without ischemic findings (19.41 vs 11.59).

Q: What question did this study set out to answer?

The study aims to assess how effectively right-sided ECG can identify right ventricular ischemia in NSTEMI patients.

Key Result

Right-sided ECG ischemic findings in NSTEMI patients were associated with significantly higher mean SYNTAX scores compared to patients without ischemic findings (19.41 vs 11.59).

Key Points

The study aims to assess how effectively right-sided ECG can identify right ventricular ischemia in NSTEMI patients.
Prospective, single-center trial including 114 NSTEMI patients.
Standard and right-sided ECGs were obtained and evaluated for ischemic findings.
Comparative analysis of SYNTAX scores and 1-month MACE rates between groups.
40 patients (35.1%) exhibited ischemic findings on right-sided ECG.
5 patients (4.4%) had ST elevation in V3R–V5R leads, indicating right ventricular myocardial infarction.
Mean SYNTAX score was significantly higher in patients with ischemic findings (27.3 ± 10.83) versus those without (11.59 ± 8.88; p < 0.001).

Study Design

Type

Observational (n=114)

Multicenter

Structured PICO

Does the presence of ischemic findings on right-sided ECG identify higher SYNTAX scores and worse 1-month MACE rates in patients with NSTEMI?

Population

114 patients with non-ST-segment elevation myocardial infarction (NSTEMI), mean age 64.04, 62.3% male, single-center in Turkey. Exclusions: hemodynamic instability, ST elevation during follow-up, posterior MI findings, Wellen pattern on standard ECG, non-ACS causes of elevated troponin, pregnant patients, and widespread ST depression and ST elevation in aVR suggesting a left main coronary lesion.

Intervention

Right-sided electrocardiogram (ECG) evaluating for ischemic findings (ST segment elevation > 1 mm in V3R-V5R leads, ST segment depression > 0.5 mm, or T wave inversion > 1 mm).

Comparator

NSTEMI patients without ischemic findings on right-sided ECG.

Outcome

SYNTAX scores and 1-month major cardiac adverse event (MACE) rates.composite

Ischemic findings on right-sided ECG in NSTEMI patients correlate with more complex coronary artery disease (higher SYNTAX scores), suggesting a potential role for right-sided ECG to identify patients who may benefit from early angiography.

Main Result

Absolute Event Rate: 19.41% vs 11.59%

p-value: p=<0.001

Limitations

Right-sided ECGs were not always obtained simultaneously with the initial standard ECGs, often after antiplatelet/anticoagulant therapy was given
Short follow-up period of 1 month for major adverse cardiac events (MACE)
Potential confounders such as pre-existing comorbidities and medication use were not fully adjusted for in the analysis
Low prevalence of right ventricular MI in the cohort limited statistical power to detect differences in clinical outcomes

Abstract

This study aims to evaluate the effectiveness of right-sided ECG in identifying RV ischemia or infarction in NSTEMI patients and to compare the SYNTAX scores and 1-month major cardiac adverse event (MACE) rates between patients with and without ischemic findings on right-sided ECG. This prospective, single-center study included 114 NSTEMI patients. Standard and right-sided ECGs were obtained, and ischemic findings were evaluated. The presence of ST elevation in the V3R-V5R leads on the right-sided ECG was used to diagnose right ventricular myocardial infarction. SYNTAX scores and 1-month MACE rates were compared between patients with and without ischemic findings on right-sided ECG. A total of 40 patients (35.1%) demonstrated ischemic findings on the right-sided ECG. Five patients (4.4%) showed ST elevation in the V3R–V5R leads, suggesting right ventricular myocardial infarction. The mean SYNTAX score in patients with ischemic findings on right-sided ECG was significantly higher (27.3 ± 10.83) compared to those without ischemic findings (11.59 ± 8.88; p < 0.001). This study demonstrates the potential benefit of right-sided ECG in diagnosing right ventricular infarction or ischemia in NSTEMI patients, which may facilitate early angiography and improve prognosis.

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Cite This Study

Şaşmaz et al. (Sun,) conducted a observational in Non-ST-segment elevation myocardial infarction (NSTEMI) (n=114). Right-sided electrocardiogram (ECG) vs. Patients without ischemic findings on right-sided ECG was evaluated on SYNTAX score (p=<0.001). Right-sided ECG ischemic findings in NSTEMI patients were associated with significantly higher mean SYNTAX scores compared to patients without ischemic findings (19.41 vs 11.59).

synapsesocial.com/papers/69f04e9b727298f751e7280e https://doi.org/https://doi.org/10.1186/s13019-026-04183-w

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