Faculty of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran.
Department of Cardiology Medicine, Al-Zahra Charity Hospital, Shiraz University of Medical Sciences, Zand St, PO Box: 71348-14336, Shiraz, Iran.
BMC Cardiovasc Disord. 2022 Jan 12;22(1):8. doi: 10.1186/s12872-022-02455-6.
SYNTAX score is one of the risk assessment systems to predict cardiac events in acute coronary syndrome patients. Despite the large number of SYNTAX score benefits, invasive methods such as coronary angiography are necessary to perform the scoring. We hypothesized that ECG parameters could predict the SYNTAX score in unstable angina patients.
During the retrospective cohort study, a total number of 876 patients were diagnosed with unstable angina. After applying the exclusion criteria, 600 patients were divided into tertiles based on the SYNTAX scores as low (0-22), intermediate (23-32), and high (≥ 33). The association between ECG parameters and SYNTAX score was investigated.
The study included 65% men and 35% women with a mean age of 62.4 ± 9.97 years. The delayed transition zone of QRS complex, ST-depression in inferior-lateral territories or/and in all three territories, and T-wave inversion in lateral territory were significant (p < 0.05) independent predictors of intermediate SYNTAX score. High SYNTAX score was predicted by the presence of prolonged P wave duration, ST-depression in lateral territory or/and anterior-lateral territories, ST-elevation in aVR-III leads or/and aVR-III-V1 leads. Among those, all three territories ST-depression (AUC: 0.611, sensitivity: 75%, specificity: 51%) and aVR + III ST-elevation (AUC: 0.672, sensitivity: 50.12%, specificity: 80.50%) were the most accurate parameters to predict intermediate and high SYNTAX scores, respectively.
The present study demonstrates that accompanying the STE in the right side leads (aVR, III, V1) with ST-depression in other leads indicates the patients with high SYNTAX score; meanwhile, diffuse ST-depression without ST-elevation is a marker for intermediate SYNTAX score in unstable angina patients and can be applied for early risk stratification and intervention.
SYNTAX 评分是预测急性冠状动脉综合征患者心脏事件的风险评估系统之一。尽管 SYNTAX 评分有很多好处，但进行评分仍需要进行有创的方法，如冠状动脉造影。我们假设心电图参数可以预测不稳定型心绞痛患者的 SYNTAX 评分。
在回顾性队列研究中，共诊断出 876 例不稳定型心绞痛患者。应用排除标准后，根据 SYNTAX 评分将 600 例患者分为低（0-22）、中（23-32）和高（≥33）三分位。研究了心电图参数与 SYNTAX 评分之间的关系。
研究包括 65%的男性和 35%的女性，平均年龄为 62.4±9.97 岁。QRS 波群延迟过渡区、下外侧和/或所有三个区域的 ST 压低以及外侧区域的 T 波倒置是中间 SYNTAX 评分的显著（p<0.05）独立预测因子。高 SYNTAX 评分预测指标为 P 波持续时间延长、外侧或前外侧区域的 ST 压低、aVR-III 导联或 aVR-III-V1 导联的 ST 抬高。其中，所有三个区域的 ST 压低（AUC：0.611，灵敏度：75%，特异性：51%）和 aVR+III 的 ST 抬高（AUC：0.672，灵敏度：50.12%，特异性：80.50%）是预测中、高 SYNTAX 评分最准确的参数。
本研究表明，右侧导联（aVR、III、V1）的 STE 伴有其他导联的 ST 压低提示患者 SYNTAX 评分较高；同时，无 ST 抬高的弥漫性 ST 压低是不稳定型心绞痛患者中值 SYNTAX 评分的标志物，可用于早期风险分层和干预。
