Less Recognized ECG Changes Associated with Significant Ischemia; Concerning the Minnesota Coding System

Background: An electrocardiogram (ECG) is a commonly used, noninvasive, cost-effective tool widely available for diagnosing patients with coronary artery disease. It is associated with significant myocardial ischemia due to Coronary artery disease (CAD), which is associated with specific ECG changes. Objectives: The goals were to determine less well-known ECG changes associated with significant ischemia and assess their potential value as early markers for diagnosing myocardial ischemia in patients with CAD. Methods: Data were obtained from participants in the MASHAD cohort study. The characteristics obtained, including fasting blood glucose, lipid profile, history of diabetes mellitus, history of hypertension, and history of previous CVD, were recorded. A ۱۲-lead ECG was also obtained for each subject and coded for specific ECG changes using Minnesota (MN) codes. Patients were divided into two groups based on MN coding for significant ischemia. A p-value less than ۰.۰۵ was considered significant. Results: Out of ۹۰۳۵ coded ECGs,۱۲۷۶ (۱۴.۱%) had significant myocardial ischemia. After applying backward binary logistic regression, left- and right-axis deviations were significantly associated with significant ischemia (OR=۲.۴۸۲, p<۰.۰۰۱; OR=۲.۷۵۷, p=۰.۰۲۳, respectively). Left Ventricular (OR=۲.۱۷۱, p=۰.۰۲۰) and right ventricular hypertrophy (OR=۵.۷۴۷, p=۰.۰۰۴) showed significant associations. Other indicators, including minor T-wave abnormalities (OR=۳.۲۴۹, p<۰.۰۰۱), left anterior hemiblock (OR=۴.۷۱۱, p=۰.۰۰۱), and notched and widened P wave (OR=۲.۴۱۵, p<۰.۰۰۱), were also significantly associated with significant ischemia. Conclusion: These findings suggest that the identified ECG changes may serve as novel indicators or associated markers of central ischemia. However, more longitudinal studies are needed to evaluate each of these abnormalities in patients with CAD.

کلیدواژه ها:

Coronary Artery Disease ، Electrocardiogram ، Minnesota Codes ، Myocardial Ischemia