Methods

This was an observational study of 142 patients with the chief complaint of chest pain, each of whom presented with a normal ECG and was subjected to emergency coronary angiography (CAG). Two population subsets were identified: those patients (n= 97) with no significant stenotic lesions and those (n= 45) with the significant stenotic lesions of CAD.

Results

Those patients with normal or nonspecific ECGs and CAD (15.8%) were more likely to have left circumflex artery involvement (20% vs. 7%). In patients with normal ECGs and CAD (vs. normal CAG), male sex (86.7% vs. 68%, p= 0.023), creatine kinase-MB (CK-MB) levels> 10 U/L (13 vs. 10, p= 0.025), and fragmented QRS (fQRS)(38.6% vs. 21.6%, p= 0.042) occurred with greater frequency. In multivariable analysis, the following variables were significant predictors of CAD, given a normal ECG: male sex (odds ratio [OR], 2.593; 95% confidence interval [CI], 1.068 to 5.839); CK-MB (OR, 2.497; 95% CI, 0.955 to 7.039); and W-or M-shaped QRS complex (OR, 2.306; 95% CI 0.988 to 5.382).

Conclusions

In our view, male sex, elevated CK-MB (> 10 U/L), and fQRS complexes are suspects for CAD in patients with angina and unremarkable ECGs and should be considered screening tests.