ECG patterns suggestive of high-risk coronary anatomy in non-ST-segment elevation acute coronary syndrome - an analysis of real-world patients

Natalia Gołąbek; Wojciech Jakubowski; Szymon Król; Mateusz Kozioł; Łukasz Niewiara; Paweł Kleczyński; Jacek Legutko; Artur Dziewierz; Andrzej Surdacki; Michał Chyrchel

doi:10.5114/aic.2023.132161

ECG patterns suggestive of high-risk coronary anatomy in non-ST-segment elevation acute coronary syndrome - an analysis of real-world patients

Postepy Kardiol Interwencyjnej. 2023 Dec;19(4):326-332. doi: 10.5114/aic.2023.132161. Epub 2023 Oct 18.

Affiliations

¹ Students' Scientific Group at the Second Department of Cardiology, Jagiellonian University Medical College, Krakow, Poland.
² Students' Scientific Group of Modern Cardiac Therapy at the Department of Interventional Cardiology, Jagiellonian University Medical College, John Paul II Hospital, Krakow, Poland.
³ Department of Interventional Cardiology, Institute of Cardiology, Jagiellonian University Medical College, John Paul II Hospital, Krakow, Poland.
⁴ Second Department of Cardiology, Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland.

Abstract

Introduction: Electrocardiographic (ECG) patterns suggestive of high-risk coronary anatomy are indications for an urgent invasive approach in non-ST-segment elevation acute coronary syndrome (NSTE-ACS).

Aim: To estimate the frequency of the observed phenomenon and assess the clinical characteristics of NSTE-ACS subjects associated with Wellens syndrome, the de Winter sign, or ST-segment depressions by ≥ 1 mm in ≥ 6 classic ECG leads with simultaneous ST-segment elevation in aVR and/or V1.

Material and methods: Out of 207 pre-screened subjects diagnosed with NSTE-ACS, 64 patients (26 women and 38 men) with complete medical records (including admission ECG and coronary angiography during the index hospitalization), and significant culprit stenosis or occlusion of the left main coronary artery (LMCA) or the proximal/middle segment of the left anterior descending artery (LAD) entered the final analysis. Clinical characteristics of patients exhibiting any of the high-risk ECG patterns was compared to their counterparts with significant lesions in LMCA or proximal/middle LAD without any of the high-risk ECG patterns.

Results: Among 64 patients with significant culprit lesions in LMCA or LAD, 19 (29.69%) exhibited one of the high-risk ECG patterns: Wellens syndrome (n = 10), the de Winter sign (n = 0), or multiple ST-segment depressions (n = 9). Clinical characteristics were comparable in 19 NSTE-ACS patients with the high-risk ECG patterns and their 45 counterparts.

Conclusions: Because ECG patterns suggestive of high-risk coronary anatomy are relatively frequent in patients with NSTE-ACS and culprit lesions in LMCA or LAD, their early recognition is of clinical importance.

Keywords: ST-elevation myocardial infarction equivalents; Wellens syndrome; aVR ST-segment elevation; non-ST-segment elevation acute coronary syndrome.