Electrocardiogram Changes in Patients with Positive Troponin I Presenting with Non-ST-Elevation Myocardial Infarction

Abstract

Objectives: Unlike “ST-segment elevation myocardial infarction (STEMI)”, there is a wide spectrum of ECG changes for Non-STEMI (NSTEMI) patients with varying prognostic implications. Therefore, the purpose of this study was to determine the frequency of ECG changes in patients with positive high-sensitive troponins (hs-cTn) presenting with NSTEMI.

Methodology: This Cross sectional study included 282 patients with positive hs-cTn diagnosed with NSTEMI. Standard 12-lead ECG was performed for all the patients. The clinical profile and ECG changes such as ST elevation in aVR, T wave inversion, and ST depression were noted.

Results: Out of 282 patients, 68.1% (192) were male, mean age was 58.5 ± 10.6 years, 56.7% (160) were hypertensive, and 39.7% (112) were diabetic. The ECG was normal in 8.2% (23) while, 64.5% (182) had ST-depression, out of which 1.1% (2) had ST-depression of <1mm, 78% (142) had ST-depression of 1-2mm, and remaining 20.9% (38) had ST-depression of >2mm. T-wave inversions were observed in 45.7% (129). ST-elevation of ≥1 mm in lead aVR was noted in 19.1% (54) patients.

Conclusion: A considerable number of NSTEMI patients with positive hs-cTn showed no specific ECG changes. ST-depression followed by T wave inversion and ST-elevation in aVR were the most commonly observed ECG findings in these patients. Considering the prognostic implications and association of these changes with the severity of diseases, prompt decision-making regarding invasive management strategy could be helpful in improving the outcomes of these patients.