Study of 12-Lead ECG and Coronary Artery Stenosis in Angiography Cases

1. The study of 12-leads electrocardiogram related to significant coronary artery stenosison 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 >> 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. Ref:CAD 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. 1996;27:964–1047

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

7. Methodology • Retrospective Cross-sectional study

8. Data collection and tools used to collect data • CAG • ECG • Sex • Underlying disease • Smoking • Drug used • - aspirin • - clopidogrel • Angina pectoris • Dyspnea • Non specific symptom • FBS • Cr • TG • TC • HDL • LDL section 4 section5 section 3: Laboratory section2:clinical presentation section1: patient characteristic

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 (n=195) Sex (n=195)

13. Results Number of patients (%) n=134 n=45 n=168 n=7 n=91 n=166 n=87

14. Results Number of patients (%) n=173 n=111 n=77

15. Results Number of patients(%)

16. Discussion

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. 2005;58(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 2010;362:886-95. • World Heart Organization. Cardiovascular diseases (CVDs) [online]. [cited 2011July20] ; Available from: http://www.who.int/mediacentre/ factsheets/fs317/ en/index.html • กระทรวงสาธารณสุข, สำนักนโยบายและยุทธศาสตร์, ข้อมูลสถิติ.[online].cited2011September 15] ;Available from: http://bps.ops.moph.go.th/index.php?mod=bps&doc=5 • ชยันตร์ธร ปทุมานนท์, ระบาดวิทยาการแพทย์, ภาควิชาเวชศาสตร์ชุมชน คณะแพทยศาสตร์ มหาวิทยาลัยเชียงใหม่, 2541 • จริยา เลิศอรรฆยมณี, งานวิจัยทางคลินิก, คณะแพทยศาสตร์ศิริราชพยาบาล มหาวิทยาลัยมหิดล, 2544