Pattern of Coronary Artery Disease and Frequency of Left Circumflex Artery as a Culprit in Patients of Non-ST Elevation Acute Coronary Syndrome with a Normal Electrocardiogram

Objective: To determine the pattern of Coronary Artery Disease in patients presenting with Non ST-Elevation Acute Coronary Syndrome(NSTE-ACS) with a normal Electrocardiogram (ECG) and to assess the frequency of left circumflex artery as a culprit artery. Study Design: Analytical Cross-sectional Study. Place and Duration of Study: In Armed Forces Institute of Cardiology/National Institute of Heart Diseases Rawalpindi,Pakistan, from Aug 2022 to Jan 2023. Methodology: A total of n=118 patients with NSTE-ACS, presenting within 24-hours of symptoms onset, with a normal ECG reports, were recruited using non-probability consecutive sampling. Demographics, Ejection fraction, and Coronary angiography findings were noted. Coronary Angiography was done as per standard protocol. The number of diseased vessels was recorded. Data management and analysis were done on SPSS version-26;00. Mean±SD along with frequencies & percentages were used to express quantitative and qualitative variables respectively. Chi square and Student t-test were applied and p-value <0.05 was taken as statistically significant. Results: Out of the 118 patients, 86(72.0%) were males. Mean age of the patients was 60.269.67 years. The coronary angiography showed Triple Vessel Coronary Artery Disease (TVCAD) in 50(42.4%) patients, double and single vessel coronary artery disease in 22(18.6%) and 43(36.4%) patients, respectively. The culprit artery was found to be Left circumflex artery in 77(65.3%), left anterior descending in 69(58.5%) and Right coronary artery in 49(39.0%) of the patients. Conclusion: Majority of the patients with normal ECG and NSTE-ACS had TVCAD and the Left Circumflex artery was the most common Culprit in such patients.