ST-segment and T-wave changes among patients with Non-ST Elevation Myocardial Infarction and severe 3 vessel CAD on coronary angiogram

Background: The distinction between ST-elevation and non-ST elevation infarction is widely accepted and employed as a guide to management. However, infarction simultaneously involving opposite LV walls may create vectors that cancel out and hence may not produce the usual ST-changes on ECG.

Objective: The objective of this study is to describe ST segment and T-wave changes among patients with NSTEMI and severe 3 vessel CAD on coronary angiogram.

Methods: This is a descriptive, cross-sectional study wherein records and ECG of adult Filipino patients with NSTEMI and severe 3-vessel CAD were reviewed.

Results: Majority of the 227 subjects were male, smoker, hypertensive, diabetic, and with family history of CAD. ST-depression was not a common finding however, T-wave inversion in V4 – V6 (54.3%) and abnormal R-wave progression (69.1%) were noted.

Conclusion: There is no specific ST-T-wave pattern in the ECG of NSTEMI patients with severe 3 vessel CAD. This is in concordance with the theory that opposing vectors from the wide area of involved myocardium in the presence of severe CAD hinders the development of significant ST and T wave shifts.