The study of 12-leads electrocardiogram related to significant coronary artery stenosis on elective coronary angiography cases

1
The study of 12-leads electrocardiogram related
to significant coronary artery stenosis on
elective coronary angiography cases

• N. Wongwiriyawanit, R. Junkai, K. Jitsopit, 5th
  year medical student
• T. Laksomya, Department of Medicine
• S. Lertkajornsin, Department of Community Family
  and Occupational Medicine
• Naresuan University Hospital

2
Introduction

• CVD was third leading cause of death in Thailand.
  
• myocardial infarction, hypertension and
  cerebrovascular disease gtgt Most common problem of
  CVD.

3
Introduction

• Chest pain most common symptom.
• Chest pain patients who arrive at the hospital
  are examined by
• 12-leads electrocardiogram (ECG)
• biochemical markers

4
Objective

• Primary aim was to study 12-leads ECG pattern
  associated with significant coronary artery
  stenosis on elective coronary angiography
  patients.
• Secondary aim was to study clinical symptoms and
  risk factors of coronary artery stenosis.

5
Definition of Coronary artery stenosis

• Significant coronary artery stenosis
• 50 or more narrowing of left main coronary
  artery
• 70 or more narrowing of other cardiac vessels.

RefCAD indicates coronary artery disease LAD,
left anterior descending coronary artery. From
Califf RM, Armstrong PW, Carver JR, et al. Task
Force 5. Stratification of patients into high-,
medium-, and low-risk subgroups for purposes of
risk factor management. J Am Coll Cardiol.
1996279641047
6
Population

• The patients whom elective coronary angiography
  cases at Naresuan University Hospital from August
  1, 2010 to July 31, 2011

Inclusion criteria Exclusion criteria
age 19 years Suspicious of coronary artery stenosis Elective CAG 12 leads ECG before CAG Acute coronary artery disease Previous PCI and CABG Valvular heart disease Congenital heart disease Myocarditis and Pericarditis
7
Methodology

• Retrospective Cross-sectional study

8
Data collection and tools used to collect data
9
Statistic method

• This was to find the factors related to coronary
  artery stenosis by chi-square test with
  reliability 95 Cl.
• STATA computer program was used to calculate
  relative risk.

10
12-leads ECG patterns

• Normal sinus rhythm - Atrial fibrillation
• Complete LBBB - Incomplete LBBB
• Complete RBBB - Incomplete RBBB
• ST segment elevation - ST segment depression
• Inverted T wave - Flat T wave
• Peak T wave - Pathologic Q wave
• Non specific ECG

11
Results
435 pt.
33 pt. emergency indication (ACS or AMI)
402 pt.
78 pt. previous PCI or CABG
324 pt.
98 pt. other heart disease
226 pt.
31 pt. not enough data
Sample size 195
12
Results
Number of patients ()
Age (n195)
Sex (n195)
13
Results
Number of patients ()
n134 n45 n168
n7 n91 n166 n87
14
Results
Number of patients ()
n173 n111
n77
15
Results
Number of patients()
16
Discussion
RR 95CI p-value
Electrocardiogram Atrial fibrillation Inverted T wave Flat T wave Pathologic Q wave 0.157 1.244 0.778 1.247 0.025-0.996 1.033-1.498 0.613-0.986 1.037-1.500 lt0.05 0.021 0.038 0.019
Characteristics Diabetes mellitus Cerebrovascular accident Aspirin Clopidogrel 1.333 1.562 1.938 1.422 1.120-1.588 1.413-1.726 1.206-3.114 1.175-1.720 0.001 lt0.05 0.006 lt0.05
Laboratory Fasting blood sugar Serum creatinine LDL 1.233 1.280 1.463 1.022-1.489 1.069-1.533 1.144-1.871 0.029 0.007 0.002
17
Conclusion

• The main findings of this study showed that
  patient with inverted T wave and pathologic Q
  wave on electrocardiogram increased risk Coronary
  artery stenosis.

18
Outcomes and Benefits

• To know association between 12-leads ECG pattern
  and significant coronary artery stenosis.
• To know important symptom, that was related with
  significant coronary artery stenosis.
• To know risk factors causing of significant
  coronary artery stenosis.
• Patient who had 12-leads ECG and clinical
  symptoms were associated with significant
  coronary artery stenosis in this result, that
  would have been considered for proper
  investigation and reduced severity of disease to
  decrease morbidity and mortality.

19
Suggestion

• Incomplete information was caused by limited time
  period, therefore this study should have more
  time to complete information.
• Some medical records were not complete
  information, which caused difficult for analysis
• The researchers should study other risk factors,
  that may be associated with significant coronary
  artery stenosis.

20
Reference

• Paul Kligfield M.D., Leonard S. Gettes, M.D.,et
  al. Recommendations for the standardization and
  Interpretation of the Electrocardiogram. Journal
  of the American College of Cardiology 2007
• Patrick J. Scanlon M.D., David P. Faxon, M.D.,et
  al. ACC/AHA Guidelines for Coronary Angiography.
  Journal of the American Heart Association. 1999
• Kriengkrai Hengrussamee, MD, Wirash
  Kehasukcharoen, MD, Sudaratana Tansuphaswadikul,
  MD., Significance of Lead aVR ST Segment
  Elevation in Acute Coronary Syndrome. J Med Assoc
  Thai Vol. 88 No. 10 2005.
• Manuel Martinez-Selles, Javier Ortiz, Alvaro
  Esevez, et al. A New Risk Score for Patients With
  a Normal or Non-Diagnostic ECG Admitted to a
  Chest Pain Unit. Rev Esp Cardiol.
  200558(7)782-8.
• Manesh R. Patel, M.D., Eric D. Peterson, M.D.,et
  al. Low Diagnostic Yield of Elective Coronary
  Angiography. N Engl J Med 2010362886-95.
• World Heart Organization. Cardiovascular diseases
  (CVDs) online. cited 2011July20 Available
  from http//www.who.int/mediacentre/
  factsheets/fs317/ en/index.html
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