Electrocardiography as a Predictor of Left Main or Three-Vessel Disease in Patients with Non-ST Segment Elevation Acute Coronary Syndrome

Abstract

Objective: We aim to identify ECG changes which predicting left main /or 3-vessel disease (LM/3VD) in patients with non-ST-segment elevation acute coronary syndromes (NSTE-ACS).

Materials and Methods: The research was conducted on 139 patients presenting with non-ST segment elevation acute coronary syndromes, who admitted to AlMowasat University Hospital in Damascus and Al-Assad University Hospital in Damascus during the period between 1/2/2020 till 1/2/2021. All patients had full history, clinical examination, laboratory investigations including cardiac Troponin and renal function, also coronary angiography was done. ECG was analyzed to assess the degree of ST segment elevation in aVR, ST segment depression in other leads and the maximal QRS was analyzed.

Results: Troponin positivity had predictive accuracy 71%, sensitivity of 58.3% , specificity of 75.7%, positive predictive value of 45.7% and negative one of 83.9%. A 0.5 mm cut off for aVR ST elevation had predictive accuracy of 76 %, 61.1% sensitivity and 80.6% specificity, PPV of 52.4% and NPV of 86%. while 100 ms cut off for QRS Prolongation had predictive accuracy 80.6%, 58.3% sensitivity and 88.4 specificity, PPV: 63.6% and NPV: 85.8.

Conclusions: A positive-troponin has a moderate predictive ability while a maximal QRS duration and ST-segment elevation in lead aVR are useful predictors of LM/3VD in patients with NSTE-ACS.