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

BACKGROUND

Patients with acute coronary syndrome without ST-segment elevation in ECG have a serious prognosis with increased risk of a new myocardial infarction and death. The prognosis depends on the artery involved.

MATERIAL AND METHODS

The value of ECG at rest for detection of proximal stenosis in the left descending coronary artery (LAD) was evaluated prospectively in 138 consecutive patients with acute coronary syndrome without ST-segment elevation.

RESULTS

Negative or biphasic T-wave in lead V 2-V 3 was observed in 31/138 (22%) patients. Ichemia-related stenosis in proximal LAD was found in 25/138 (18%) patients. Negative or biphasic T-wave in V 2-V 3 was observed more often in patients with ischemia-related LAD stenosis than in other patients (76% versus 11%, p < 0.01). Troponin T or clinical risk score did not identify patients with ischemia-related LAD stenosis.

CONCLUSIONS

A biphasic or negative T-wave in lead V 2-V 3 can be used as a reliable method to diagnose proximal LAD stenosis in acute coronary syndrome, and should be used as a selection criterion for referral of patients to urgent coronary angiography and intervention.