{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T15:34:31Z","timestamp":1787758471274,"version":"build-2784847793"},"reference-count":23,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"3","content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2022,7]]},"abstract":"\n Background:<\/jats:title>\n Clinical guidelines recommend risk stratification of non-ST elevation acute coronary syndrome (NST-ACS) using the GRACE risk score. However, the GRACE risk score is not followed widely in clinical practice due to various reasons. Our primary objectives of this study were to correlate the presenting electrocardiogram (ECG) of NST-ACS with coronary angiography (CAG) findings and to identify specific ECG changes that are suggestive of severe coronary artery disease (CAD) thus helping to triage all patients with NST-ACS.<\/jats:p>\n <\/jats:sec>\n \n Materials and Methods:<\/jats:title>\n \n This prospective observational study was undertaken on patients diagnosed with NST-ACS in a medical college hospital, in Northern India over one and a \u00bd years. The admission ECG of the patients was compared with CAG findings to find out the correlation between the two with respect to severity of CAD. Categorical and quantitative variables were compared using the Chi-square test and independent\n t<\/jats:italic>\n -test, respectively. Odds ratio (OR) were calculated using the univariate logistic regression analysis.\n <\/jats:p>\n <\/jats:sec>\n \n Results:<\/jats:title>\n \n On comparing the two groups with normal and abnormal ECG, we found that smokers had significantly higher odds of having an abnormal ECG (OR 3.31; 95% confidence interval [CI] [1.29\u20138.50]). Patients with an abnormal ECG had significantly lower left ventricular ejection fraction compared to those with normal ECG (52.01 \u00b1 10.56 vs. 55.96 \u00b1 6.13%,\n P<\/jats:italic>\n = 0.045). The patients with severe CAD on CAG had significantly higher odds of abnormal ECG (OR 3.68, 95% CI [1.2311.04]). Of the specific ECG abnormalities, ST depression and T-wave inversion in same or different leads were significantly associated with severity of CAD (OR 0.13, 95% CI [0.04\u20130.43],\n P<\/jats:italic>\n = 0.001 and OR 0.13, 95% CI [0.03\u20130.46],\n P<\/jats:italic>\n = 0.002, respectively).\n <\/jats:p>\n <\/jats:sec>\n \n Conclusion:<\/jats:title>\n The identification of ECG changes suggestive of high-risk CAD can dictate to transfer such patients without delay to a percutaneous coronary intervention capable hospital for urgent CAG with intent to revascularization, thus helping in risk stratification of NST-ACS at the community level.<\/jats:p>\n <\/jats:sec>","DOI":"10.4103\/aam.aam_85_20","type":"journal-article","created":{"date-parts":[[2022,9,27]],"date-time":"2022-09-27T05:19:13Z","timestamp":1664255953000},"page":"173-179","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":3,"title":["The Role of 12-Lead Electrocardiogram in the Risk Stratification of Non-St Elevation Acute Coronary Syndrome and the Correlation with Coronary Angiography - The CINCHONA Study - A Prospective Cohort Study in Northern India"],"prefix":"10.4103","volume":"21","author":[{"given":"Barun","family":"Kumar","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ashwin","family":"Kodliwadmath","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amar Nath","family":"Upadhyay","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ranjit Kumar","family":"Nath","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Neeraj","family":"Pandit","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Harsh","family":"Wardhan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anupam","family":"Singh","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"R1-1-20240831","doi-asserted-by":"crossref","first-page":"455","DOI":"10.1111\/j.1742-6723.2009.01229.x","article-title":"Adverse outcomes following emergency department discharge of patients with possible acute coronary syndrome","volume":"21","author":"Loten","year":"2009","journal-title":"Emerg Med Australas"},{"key":"R2-1-20240831","doi-asserted-by":"crossref","first-page":"267","DOI":"10.1093\/eurheartj\/ehv320","article-title":"2015 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation: Task Force for the Management of Acute Coronary Syndromes in Patients Presenting without Persistent ST-Segment Elevation of the European Society of Cardiology (ESC)","volume":"37","author":"Roffi","year":"2016","journal-title":"Eur Heart J"},{"key":"R3-1-20240831","doi-asserted-by":"crossref","first-page":"437","DOI":"10.1016\/j.amjcard.2005.09.073","article-title":"Frequency and consequences of recording an electrocardiogram >10 minutes after arrival in an emergency room in non-ST-segment elevation acute coronary syndromes (from the CRUSADE Initiative)","volume":"97","author":"Diercks","year":"2006","journal-title":"Am J Cardiol"},{"key":"R5-1-20240831","first-page":"131","article-title":"Risk stratification in non-ST elevation acute coronary syndromes: Risk scores, biomarkers and clinical judgment","volume":"8","author":"Corcoran","year":"2015","journal-title":"Int J Cardiol Heart Vasc"},{"key":"R6-1-20240831","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1016\/S0196-0644(98)70274-4","article-title":"Usefulness of automated serial 12-lead ECG monitoring during the initial emergency department evaluation of patients with chest pain","volume":"31","author":"Fesmire","year":"1998","journal-title":"Ann Emerg Med"},{"key":"R7-1-20240831","doi-asserted-by":"crossref","first-page":"2999","DOI":"10.1093\/eurheartj\/ehr236","article-title":"ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation: The Task Force for the management of acute coronary syndromes (ACS) in patients presenting without persistent ST-segment elevation of the European Society of Cardiology (ESC)","volume":"32","author":"Hamm","year":"2011","journal-title":"Eur Heart J"},{"key":"R8-1-20240831","doi-asserted-by":"crossref","first-page":"1605","DOI":"10.1161\/CIRCULATIONAHA.114.008729","article-title":"Cardiovascular diseases in India: Current epidemiology and future directions","volume":"133","author":"Prabhakaran","year":"2016","journal-title":"Circulation"},{"key":"R9-1-20240831","doi-asserted-by":"crossref","first-page":"835","DOI":"10.1001\/jama.284.7.835","article-title":"The TIMI risk score for unstable angina\/non-ST elevation MI: A method for prognostication and therapeutic decision making","volume":"284","author":"Antman","year":"2000","journal-title":"JAMA"},{"key":"R10-1-20240831","doi-asserted-by":"crossref","first-page":"2557","DOI":"10.1161\/01.CIR.101.22.2557","article-title":"Predictors of outcome in patients with acute coronary syndromes without persistent ST-segment elevation. 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The Fast Revascularisation during InStability in Coronary artery disease","volume":"23","author":"Diderholm","year":"2002","journal-title":"Eur Heart J"},{"key":"R23-1-20240831","doi-asserted-by":"crossref","first-page":"1095","DOI":"10.1056\/NEJMoa044259","article-title":"Early invasive versus selectively invasive management for acute coronary syndromes","volume":"353","author":"de Winter","year":"2005","journal-title":"N Engl J Med"},{"key":"R24-1-20240831","doi-asserted-by":"crossref","first-page":"207","DOI":"10.1111\/j.1542-474X.2004.93545.x","article-title":"ST-depression with negative T waves in leads V4-V5-a marker of severe coronary artery disease in non-ST elevation acute coronary syndrome: A prospective study of Angina at rest, with troponin, clinical, electrocardiographic, and angiographic correlation","volume":"9","author":"Nikus","year":"2004","journal-title":"Ann Noninvasive Electrocardiol"},{"key":"R25-1-20240831","first-page":"750","article-title":"Diagnostic performance of electrocardiography in the assessment of significant coronary artery disease and its anatomical size in comparison with coronary angiography","volume":"16","author":"Mahmoodzadeh","year":"2011","journal-title":"J Res Med Sci"}],"container-title":["Annals of African Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/10.4103\/aam.aam_85_20","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T15:15:27Z","timestamp":1787757327000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/10.4103\/aam.aam_85_20"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,7]]},"references-count":23,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2022]]}},"URL":"https:\/\/doi.org\/10.4103\/aam.aam_85_20","relation":{},"ISSN":["1596-3519"],"issn-type":[{"value":"1596-3519","type":"print"}],"subject":[],"published":{"date-parts":[[2022,7]]}}}