Reconsidering Electrocardiographic Predictors of Culprit Coronary Artery Occlusion in NSTEMI Patients

This letter provides a critical appraisal of the study by Wei et al. on clinical and electrocardiographic predictors of left circumflex artery occlusion in NSTEMI patients. While the authors identified STV5 + STV6 ≥ 2.5 mm and T-wave imbalance as potential markers, concerns remain regarding the single-center, retrospective design, limited sensitivity of ECG findings, and the lack of significant differences in clinical outcomes. Prior meta-analyses suggest a higher risk in patients with occluded culprit arteries, highlighting inconsistencies with the present study. Future research should employ multicenter prospective designs and advanced diagnostic modalities, including posterior ECG leads and artificial intelligence-based analysis, to improve detection and risk stratification of culprit LCX occlusion in NSTEMI.