Department of Cardiology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India.
Department of Cardiology, Coronation Hospital, Dehradun, Uttarakhand, India.
Ann Afr Med. 2022 Jul-Sep;21(3):173-179. doi: 10.4103/aam.aam_85_20.
Clinical guidelines recommend risk stratification of non-ST elevation acute coronary syndrome (NST-ACS) using the GRACE risk score. However, the GRACE risk score is not followed widely in clinical practice due to various reasons. Our primary objectives of this study were to correlate the presenting electrocardiogram (ECG) of NST-ACS with coronary angiography (CAG) findings and to identify specific ECG changes that are suggestive of severe coronary artery disease (CAD) thus helping to triage all patients with NST-ACS.
This prospective observational study was undertaken on patients diagnosed with NST-ACS in a medical college hospital, in Northern India over one and a ½ years. The admission ECG of the patients was compared with CAG findings to find out the correlation between the two with respect to severity of CAD. Categorical and quantitative variables were compared using the Chi-square test and independent t-test, respectively. Odds ratio (OR) were calculated using the univariate logistic regression analysis.
On comparing the two groups with normal and abnormal ECG, we found that smokers had significantly higher odds of having an abnormal ECG (OR 3.31; 95% confidence interval [CI] [1.29-8.50]). Patients with an abnormal ECG had significantly lower left ventricular ejection fraction compared to those with normal ECG (52.01 ± 10.56 vs. 55.96 ± 6.13%, P = 0.045). The patients with severe CAD on CAG had significantly higher odds of abnormal ECG (OR 3.68, 95% CI [1.2311.04]). Of the specific ECG abnormalities, ST depression and T-wave inversion in same or different leads were significantly associated with severity of CAD (OR 0.13, 95% CI [0.04-0.43], P = 0.001 and OR 0.13, 95% CI [0.03-0.46], P = 0.002, respectively).
The identification of ECG changes suggestive of high-risk CAD can dictate to transfer such patients without delay to a percutaneous coronary intervention capable hospital for urgent CAG with intent to revascularization, thus helping in risk stratification of NST-ACS at the community level.
临床指南建议使用 GRACE 风险评分对非 ST 段抬高型急性冠状动脉综合征（NSTE-ACS）进行风险分层。然而，由于各种原因，GRACE 风险评分并未在临床实践中广泛应用。我们这项研究的主要目的是将 NSTE-ACS 的初始心电图（ECG）与冠状动脉造影（CAG）结果相关联，并确定提示严重冠状动脉疾病（CAD）的特定 ECG 变化，从而帮助分诊所有 NSTE-ACS 患者。
这项前瞻性观察研究在印度北部的一所医学院附属医院对诊断为 NSTE-ACS 的患者进行，共进行了 1 年半的时间。将患者入院时的 ECG 与 CAG 结果进行比较，以发现两者在 CAD 严重程度方面的相关性。使用卡方检验比较分类变量，使用独立 t 检验比较定量变量。使用单因素逻辑回归分析计算比值比（OR）。
在比较 ECG 正常和异常的两组患者时，我们发现吸烟者发生异常 ECG 的可能性明显更高（OR 3.31；95%置信区间[CI] [1.29-8.50]）。与 ECG 正常的患者相比，ECG 异常的患者的左心室射血分数明显更低（52.01±10.56 与 55.96±6.13%，P=0.045）。CAG 显示严重 CAD 的患者发生异常 ECG 的可能性明显更高（OR 3.68，95%CI [1.2311.04]）。在特定的 ECG 异常中，同一或不同导联的 ST 段压低和 T 波倒置与 CAD 的严重程度显著相关（OR 0.13，95%CI [0.04-0.43]，P=0.001 和 OR 0.13，95%CI [0.03-0.46]，P=0.002）。
识别提示高危 CAD 的 ECG 变化可以决定立即将此类患者转至能够进行经皮冠状动脉介入治疗的医院进行紧急 CAG 以进行血运重建，从而帮助在社区层面对 NSTE-ACS 进行风险分层。
