Background: Acute coronary syndromes are the leading cause of mortality worldwide. Electrical risk score (ERS) is a novel electrocardiographic risk scoring system. The prognostic importance of ERS in non-ST elevation myocardial infarction (NSTEMI) patients is unknown. We aimed to determine the association of ERS with in-hospital prognosis in NSTEMI patients undergoing coronary angiography (CAG).

Methods: A total of 427 consecutive NSTEMI patients undergoing CAG were enrolled in this study. Six parameters comprised ERS: pulse rate >75, left ventricular hypertrophy according to Sokolow–Lyon criteria, QRS transition zone ≥V4, corrected QT (QTc) interval >450 for men and >460 for women, T peak to T end interval (Tp-e) >89 ms, and frontal QRS-T angle >90°. The ERS was calculated according to the number of abnormal findings in electrocardiogram. The study population was divided into 2 groups as ERS <3 and ≥3.

Results: No significant difference was found between ERS ≥3 and <3 groups in terms of demographic characteristics. However, patients with ERS ≥3 had significantly higher maximum troponin (P < .001), thrombolysis in myocardial infarction (P = .002), and global registry of acute coronary events (P < .001) risk scores and 3-vessel disease frequency (P = .001), whereas they had lower left ventricular ejection fraction (P < .001). These patients also had higher frequency of in-hospital mortality (P < .001) and adverse events. Multiple logistic regression analysis demonstrated that ERS (OR = 1.790, 95% CI: 1.036-3.095, P = .037) was an independent predictor of in-hospital mortality.

Conclusion: The frequency of in-hospital adverse events and mortality was significantly higher in NSTEMI patients with an ERS ≥3 at admission. This simple electrocardiographic risk marker may help identify patients at higher cardiac risk in patients presenting with NSTEMI and identify patients who may need early coronary intervention.