The association between electrocardiographic R wave peak time and coronary artery disease severity in patients with non-ST segment elevation myocardial infarction and unstable angina pectoris

Abstract Background The prediction of severe coronary artery disease(CAD) using noninvasive, easily accessible tools may improve patient prognosis by enabling early coronary angiography, aiding revascularization in patients with acute coronary syndrome. We aimed to evaluate possible association between QRS duration(QRSD), R wave peaktime(RWPT), and CAD severity identified using the SYNTAX score(SS). Method Of the 234 patients who were admitted to our center with clinical features of unstable angina pectoris(USAP) or non-ST segment elevation myocardial infarction(NSTEMI), 176 who met the inclusion criteria were enrolled in the study. Results The study population was divided into the low SS group (≤ 22, n:131) and the highSS group(> 22,n:45). The high SS group patients had a higher prevalence of diabetes mellitus (DM); presence of ST segment depression ≥ 0,5 mm(STD ≥ 0,5) and 1 mm(STD ≥ 1); ST segment elevation in the AVR lead(AVRSTE); longer QRSD and RWPT; and lower left ventricular ejection fraction (LVEF) than the low SS group. The LVEF (Odd’s ratio [OR]: 0.933, 95% confidence interval [CI]: 0.896-0.972; p = 0.001), AVRSTE (OR: 3.650, 95% CI: 1.274-10.458; p = 0.016), and RWPT (OR: 1.035, 95% CI: 1.003-1.067; p = 0.030) were independent predictors of high SS in the multivariate logistic regression analyses. While there was a moderate correlation between SS and RWPT in the study population, this correlation was good in the high SS group. Conclusion The present study demonstrated that the presence of STD, AVRSTE, as well as prolonged QRSD and RWPT were associated with CAD severity in NSTEMI/USAP patients. Further, RWPT and AVRSTE could be used as predictors of high SS.