frontal t-p angle: a novel ecg parameter for predicting syntax-1 and syntax-2 scores in acute non–st-segment elevation myocardial infarction

Background: few studies have investigated p-wave and t-wave axes, most of which focus on mortality. the frontal t-p angle (ft-pa) is a novel ecg-derived parameter of ventricular repolarization. we aimed to evaluate the association between ft-pa and syntax-1 (ss-1) and syntax-2 (ss-2) scores in patients with acute non-st-segment elevation myocardial infarction (anstemi).methods: this retrospective study included 158 anstemi patients undergoing coronary angiography. the study population was stratified based on ss-1 (≤22 vs. >22) and ss-2 (≤26.2 vs. >26.2). the ft-pa was calculated by subtracting the p-wave axis from the t-wave axis, both obtained from the ecg device's built-in software, and compared between groups.results: ft-pa showed significant correlations with age (r=0.242, p=0.003), ss-2 (r=0.229, p=0.005), and t-wave axis (r=–0.626, p<0.001). both age and ft-pa were significantly correlated with and predictive of ss-2 (β=0.679; or, 0.700 [95% ci, 0.584 to 0.816]; p<0.001 for age) and (β=0.147; or, 0.048 [95% ci, 0.012 to 0.085; p=0.010 for ft-pa). roc curve analysis identified an ft-pa cutoff of 36.5 (64% sensitivity, 68% specificity; auc, 0.674; p<0.001) for predicting ss-2 > 26.2, and a cutoff of 39.5 (70% sensitivity, 62% specificity; auc, 0.692; p=0.010) for predicting ss-1>22.conclusions: ft-pa showed a stronger correlation and association with ss-2 than with ss-1. this parameter may serve as a simple, reproducible tool for predicting coronary artery disease complexity, even in patients with normal t-wave and p-wave axis ranges.