The effectiveness of right-sided electrocardiogram in non-ST-segment elevation myocardial infarction.

OBJECTIVE: This study aims to evaluate the effectiveness of right-sided ECG in identifying RV ischemia or infarction in NSTEMI patients and to compare the SYNTAX scores and 1-month major cardiac adverse event (MACE) rates between patients with and without ischemic findings on right-sided ECG. METHODS: This prospective, single-center study included 114 NSTEMI patients. Standard and right-sided ECGs were obtained, and ischemic findings were evaluated. The presence of ST elevation in the V3R-V5R leads on the right-sided ECG was used to diagnose right ventricular myocardial infarction. SYNTAX scores and 1-month MACE rates were compared between patients with and without ischemic findings on right-sided ECG. RESULTS: A total of 40 patients (35.1%) demonstrated ischemic findings on the right-sided ECG. Five patients (4.4%) showed ST elevation in the V3R–V5R leads, suggesting right ventricular myocardial infarction. The mean SYNTAX score in patients with ischemic findings on right-sided ECG was significantly higher (27.3 ± 10.83) compared to those without ischemic findings (11.59 ± 8.88; p < 0.001). CONCLUSION: This study demonstrates the potential benefit of right-sided ECG in diagnosing right ventricular infarction or ischemia in NSTEMI patients, which may facilitate early angiography and improve prognosis.