| Abstract: |
Background:The management of patients with an acute coronary syndrome (ACS) requires accurate risk stratification to guide appropriate therapy.Acute coronary syndrome remains the leading cause of morbidity and mortality worldwide. It describes a spectrum of clinical syndromes ranging from unstable angina (UA) and non-ST-elevation myocardial infarction (NSTEMI) to ST-elevation myocardial infarction (STEMI). In this context NSTEMI is distinguished from UA by the presence of elevated serum level of cardiac biomarkers patients. Non-ST-elevation myocardial infarction have a higher late mortality (8.9% at 6 months), compared with ST-elevation myocardial infarction (6.8% at 6 months).As the patients with NSTE-ACS (UA and NSTEMI) represent a heterogeneous group with the worst prognosis in patients with LM / 3VD disease, so an early identification of patients with LM/3VD disease is an important factor in the prognosis and selection of the optimal treatment strategy in patients with NSTE-ACS. In these patient (with LM/3VD) an early invasive approach will be of greater benefit when compared with conservative medical treatment. Early revascularization reduces the risk of death/MI, decreases the need for antianginal medications, allows a shorter hospital stay, and results in fewer readmissions.The Thrombolysis in Myocardial Infarction (TIMI) Risk Score for stratification of patients with non- ST-segment-elevation myocardial infarction (MI) was derived from the population of the TIMI 11B trial.Objectives: The present study aimed To investigate the accuracy of early noninvasive clinical parameters including ( Risk factors , ST-segment elevation in lead aVR , ST-segment depression , Troponin T levels and TIMI risk score) in the early prediction of angiographic extent and severity of coronary artery disease among patients presenting with ACS.Patient and methods: A total of 60 patients presenting with ACS were included in this study. Basic clinical data, electrocardiographic data, Troponin T assay, calculation of the TIMI risk score and angiographic data were obtained for each patient.Statistical analysis was done to detect the relationship between different parameters and the incidence of LM/3VD.Results: from the present study, it was shown that ST-segment elevation in lead aVR ≥0.5 mm (P<0.001*) was the strongest predictor of LM/3VD followed by Maximal ST-segment depression ( mm ) (P=0.001*) then TIMI risk score (P=0.041*) and lastly positive Troponin T (P<0.05*) in patients with ACS.The sensitivity and specificity of ST-segment elevation in lead aVR ≥ 0.5mm for prediction of LM/3VD is 70% and 77.8% respectively which is higher than that of Troponin T (63.3% and 52.8% respectively).whereas other parameters such as diabetes , ST-segment depression ≥ 0.5 mm and number of leads showing ST-segment depression were not significant predictors of LM/3VD.Conclusion: , based on the result of this study, ST-segment elevation in lead aVR ≥ 0.5 mm , Maximal ST-segment depression ( mm ) , TIMI risk score and lastly positive Troponin T( positive Troponin T can thereby facilitate decision-making, that is, patients likely to have LM/3VD should promptly undergo an early invasive approach in order to get greater benefit as early revascularization reduces the risk of death/MI, arrhythmias, decreases the need for antianginal medications, allows a shorter hospital stay, and results in fewer readmissions. ST-segment elevation in lead aVR ≥ 0.5 mm (P<0.001*) was the strongest predictor of LM/3VD in patients with ACS.
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