Characteristics of Patients With Acute Coronary Syndrome and Normal Electrocardiogram
Aleksandra Ljubojevic1, Sofija Aleksandra Neskovic1, Ivona Vranic1
1Clinical Hospital Centre Zemun, Department of Cardiology, Belgrade, Serbia.
Insights
Fewer than 5% of acute coronary syndrome (ACS) patients admitted with a normal electrocardiogram (ECG) had single-vessel coronary artery disease (CAD). Some of these patients showed normal troponin and LV function, complicating diagnosis.
Area of Science:
- Cardiology
- Internal Medicine
- Diagnostic Imaging
Background:
- Acute coronary syndrome (ACS) diagnosis can be challenging in patients presenting with a normal electrocardiogram (ECG).
- A normal ECG in ACS may be associated with delayed diagnosis and increased complication risks.
- Understanding the characteristics of ACS patients with normal ECGs is crucial for improving diagnostic strategies.
Purpose of the Study:
- To investigate the demographic, angiographic, and echocardiographic profiles of hospitalized ACS patients with normal admission ECGs.
- To identify specific patterns of coronary artery disease (CAD) in this patient cohort.
- To assess the occurrence of normal cardiac biomarkers and function in ACS patients with normal ECGs.
Main Methods:
- Retrospective analysis of ACS patients without ST-elevation admitted between 2015 and 2023.
- Coronary artery disease (CAD) confirmation via coronary angiography.
- Filtering and separate analysis of patients with ACS and normal ECG on admission.
Main Results:
- 129 patients (4.1%) with ACS and normal ECG were identified among 3137 suspected cases.
- The majority of these patients (54.3%) had single-vessel CAD.
- A subset of patients with single-vessel CAD (5.7%) and multi-vessel CAD (3.5%) exhibited normal troponin levels and left ventricular (LV) systolic function.
Conclusions:
- A normal ECG is infrequent in hospitalized ACS patients without ST-elevation (less than 5%).
- Single-vessel CAD is the predominant finding in this group.
- A small percentage of patients with single-vessel CAD and normal ECG may not show elevated troponin or LV asynergy, highlighting diagnostic challenges.
Background:
Patients with acute coronary syndrome (ACS) and normal electrocardiogram (ECG) may have an increased risk of late diagnosis and complications of the disease.
Objective:
To study the demographic, angiographic and echocardiographic characteristics of patients hospitalized for ACS in whom the ECG was normal on admission to the hospital.
Methods:
This retrospective study included patients who were hospitalized for ACS without ST-elevation between 2015 and 2023 and who had coronary artery disease (CAD) confirmed by coronary angiography. By further inspection of the electronic databases, patients with ACS who had a normal ECG on admission were filtered out and analyzed separately.
Results:
Of the total 3137 patients with suspected ACS without ST-elevation, 129 patients (4.1%) were diagnosed as having ACS with a normal ECG. In three patients a non-atherosclerotic cause for the ACS was found. A significantly higher proportion of patients had single-vessel (54.3%) compared to two-vessel (29.5%) and three-vessel (14%) CAD. In addition to a normal ECG, 5.7% of patients with single-vessel CAD and 3.5% of patients with multi-vessel CAD had normal troponin levels and normal regional LV systolic function on echocardiography.
Conclusion:
Less than 5% of hospitalized patients with ACS without ST-elevation had a normal ECG on admission. The majority of these patients have single-vessel CAD. In about 5% of patients with single-vessel CAD, neither elevated troponin levels nor LV asynergy are detected.
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