[Acute coronary syndrome--ECG-changes without ST-elevation]

Area of Science:

• Cardiology
• Diagnostic Imaging
• Internal Medicine

Context:

• Acute coronary syndrome without ST-segment elevation (NSTEMI) carries a significant risk of myocardial infarction and death.
• Prognosis in NSTEMI is influenced by the specific coronary artery affected.
• Accurate identification of culprit artery lesions is crucial for timely and effective treatment.

Purpose:

• To prospectively evaluate the diagnostic value of resting electrocardiogram (ECG) for detecting proximal left anterior descending (LAD) artery stenosis.
• To assess the utility of specific ECG findings (T-wave abnormalities in V2-V3) in identifying LAD stenosis in NSTEMI patients.
• To determine if ECG findings can serve as a selection criterion for urgent coronary angiography.

Summary:

• A negative or biphasic T-wave in ECG leads V2-V3 was observed in 22% of NSTEMI patients.
• This specific T-wave pattern was significantly more prevalent (76% vs. 11%, p < 0.01) in patients with confirmed ischemia-related proximal LAD stenosis.
• Troponin T levels and clinical risk scores did not effectively identify patients with proximal LAD stenosis, highlighting the diagnostic value of ECG findings.

Impact:

• A negative or biphasic T-wave in leads V2-V3 is a reliable, non-invasive marker for proximal LAD stenosis in NSTEMI.
• This ECG finding can be integrated into clinical practice to identify patients who would benefit from urgent coronary angiography and intervention.
• Improved patient selection for revascularization can lead to better outcomes and reduced mortality in NSTEMI.