Vol. 7, Issue 2, Part A (2025)

Background: The four subgroups of the electrocardiogram (ECG) might be useful in risk stratification and in choosing the best treatment plans for individuals with non-ST elevation myocardial infarction (NSTEMI). Invasive reperfusion is advised for NSTEMI patients in current guidelines in order to enhance clinical results. The purpose of this study was to evaluate the prognostic significance of qualitative ECG results in individuals who presented with myocardial infarction that was not ST-segment elevation.
Methods: This prospective cohort study was carried out on 260 patients with non-STEMI according to European society of cardiology guidelines 2023 Symptoms of ischemia (e.g. chest discomfort, angina equivalent and silent ischemia) and ECG changes indicative of new ischemia new ST-T changes or new left bundle branch block. According to the Fourth Universal Definition of Myocardial Infarction, all patients were divided into four groups based on their ECG results upon presentation: Transient ST segment elevation (TSTE) in Group I: Group II ST segment depression (STD) is defined as new or presumed-new horizontal or downsloping ST depression >0.05 mV in two contiguous leads below the isoelectric line on the ECG. TSTE is defined as new or presumed-new ST-segment elevation lasting 0.1 mV in all leads except V2-V3, where the following cut points applied: >0.2 mV in men aged >40 years, >0.25 mV in men aged 40 years, or >0.15 mV in women. T wave inversion (TWI) in group III is characterised as new or presumed-new TWI of >0.1 mV in two adjacent leads with a noticeable R wave or an R/S ratio greater than 1. Group IV NIC: If the ECG did not indicate TSTE, TW, or STD at admission, it was deemed to demonstrate NIC.
Results: In multivariate regression, Cardiac arrest, Killip Class III-IV, GP IIb IIIa inhibitor, No. of diseased vessels and global registry of acute coronary events (GRACE) score were independent predictors of Mortality, major GUSTO bleeding, reinfarction and arrhythmia while Age, sex, smoking, HTN, DM, Previous MI, Previous Percutaneous coronary intervention (PCI), Previous coronary artery bypass grafting (CABG) I, signs of congestive heart failure (CHF) on presentation, Diagnostic catheterization, systolic blood pressure, diastolic blood pressure, Heart Rate, Previous congestive heart failure, Creatinine, Troponin, Aspirin, ticagrelor, Beta blocker, angiotensin-converting enzyme inhibitor/ angiotensin ii receptor blocker (ARB), statin, anticoagulant and dyslipidemia were not. 
Conclusions: In NSTEMI patients, ST-segment depression signals higher risk, while T-wave inversion suggests a better short-term outlook. ECG aids initial risk assessment but doesn't predict outcomes after invasive treatment. A high Killip class, many diseased vasculature, the use of GP IIb/IIIa inhibitors, cardiac arrest, and GRACE score are important indicators of death.