Title : The utility of syntax score predictability by electrocardiogram parameters in patients with unstable angina
Abstract: Background: 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.
Methods: 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.
Results: 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.
Conclusion: 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.
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Decision-making about choosing the proper modality for the revascularization between the percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) was facilitated by the SYNTAX score. With the increase in CAD patients who underwent revascularization, the demand for risk stratification to predict the outcome was felt. We hypothesized that ECG parameters could predict the SYNTAX score in unstable angina patients.
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Recognizing the patients with severe CAD or intermediate and high SYNTAX scores using non-invasive tools are extremely helpful, especially for centers without advanced facilities. ECG can be used for this purpose. The present study demonstrates that accompanying the STE in the right side leads (aVR, III, V1) with STD in other leads indicates the patients with high SYNTAX score; meanwhile, diffuse depression of ST-segment without STE is a marker for intermediate SYNTAX score. These predictors aid us in early risk stratification and intervention.