Evidence for Electrocardiographic Patterns Identifying Acute Coronary Occlusion in Non-ST-Elevation Acute Coronary
Andrew P Grimes1, Sonja J Maria1
1School of Nursing, Paramedicine and Healthcare Sciences, Charles Sturt University, Bathurst, New South Wales, Australia.
Insights
Electrocardiogram (ECG) patterns can identify acute coronary occlusion (ACO) in non-ST-elevation myocardial infarction (NSTEMI) patients. However, current literature is inconsistent, limiting guideline adoption for these crucial ECG findings.
Area of Science:
- Cardiology
- Diagnostic Medicine
- Medical Informatics
Background:
- A significant portion of non-ST-elevation myocardial infarction (NSTEMI) patients present with completely occluded coronary arteries but do not receive emergent reperfusion.
- Existing literature suggests electrocardiogram (ECG) patterns can identify acute coronary occlusion (ACO) in NSTEMI, but clinical adoption remains inconsistent.
Purpose of the Study:
- To conduct a scoping review mapping the extent, characteristics, and methodologies of studies on non-ST-elevation ECG patterns for ACO detection.
- To identify gaps in the primary literature regarding diagnostic test accuracy for ECG-based ACO identification in NSTEMI.
Main Methods:
- Searched electronic databases and utilized citation tracking to identify relevant primary studies.
- Included studies evaluating non-ST-elevation ECG patterns against angiographic or composite reference standards for ACO.
- Excluded studies using stenosis severity or anatomical disease burden as the reference standard.
Main Results:
- Included 42 studies with 78 pattern-level data sources across 20 ECG patterns; only 23 evaluated undifferentiated acute coronary syndrome (ACS) patients.
- Measurable index test definitions were present in 33/78 data sources, with highly heterogeneous reference standards.
- Diagnostic test accuracy values were reported in only 29/78 data sources, predominantly for Left Bundle Branch Block (LBBB) with Ventricular Pacing Rhythms (VPR) criteria.
Conclusions:
- The existing literature on ECG patterns for ACO in NSTEMI is heterogeneous and methodologically uneven.
- Outside of LBBB/VPR criteria, diagnostic test accuracy data for NSTE-ACS populations are sparse.
- Significant gaps exist in primary research, necessitating future systematic reviews focused on pattern-specific diagnostic test accuracy.
Background:
Approximately one-quarter to one-third of patients with non-ST-elevation myocardial infarction have a completely occluded culprit coronary artery but are not routinely referred for emergent reperfusion. A growing literature describes electrocardiographic patterns purported to identify acute coronary occlusion (ACO) in non-STEMI populations, but guideline adoption has been limited and inconsistent. We conducted a scoping review to map the extent, characteristics, and methodologies of primary studies examining non-ST-elevation ECG patterns against reference standards for ACO.
Methods:
Electronic databases were searched and supplemented by backward and forward citation tracking. Primary studies were included evaluating non-ST-elevation ECG patterns against an angiographic or composite reference standard for ACO. Studies using stenosis severity or anatomical disease burden as the reference standard were excluded.
Results:
Forty-two studies were included, yielding 78 pattern-level data sources spanning 20 ECG patterns. Only 23/78 data sources evaluated undifferentiated ACS patients. Measurable index test definitions were present in 33/78 data sources. Reference standards were highly heterogeneous. Although 70/78 data sources defined a reference standard for ACO, only 29/78 reported diagnostic test accuracy values, most of which were in the LBBB/VPR category.
Conclusions:
The literature is heterogeneous, methodologically uneven, and concentrated in a small number of pattern categories. Outside the LBBB/VPR criteria, diagnostic test accuracy data in NSTE-ACS populations are sparse, and methodological features that critically affect their interpretation are inconsistently reported. These findings identify substantial gaps in the primary literature and inform the scope of future pattern-specific diagnostic test accuracy systematic reviews.
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