Predictive value of frontal QRS-T angle for no-reflow phenomenon in patients with acute coronary syndrome

BACKGROUND: Coronary no-reflow phenomenon (NRP) is a complex condition that can be observed frequently after percutaneous coronary intervention (PCI) in patients with acute coronary syndrome (ACS) and is associated with significant adverse cardiac events and a poor prognosis. In this study, we aimed to evaluate the relationship between the frontal QRS-T angle, which has been associated with myocardial repolarization and adverse cardiac outcomes in previous researches, and NRP. METHODS: Our retrospective, single center study included 1207 patients hospitalized in our clinic with ACS between 2020 and 2025. The primary endpoint in this research was the occurrence of NRP, and patients were divided into two categories according to this condition. 46 patients with NRP were identified. A control group of patients who did not occur NRP, matched 1:2 in terms of age and gender, was identified (n = 92). Electrocardiograms of the patients were evaluated before PCI and frontal QRS-T angles were recorded. Clinical features, frontal QRS-T angle, and laboratory parameters were statistically evaluated to differentiate between the two categories. RESULTS: The frontal QRS-T angle was significantly greater in the patient group with NRP than in the control group (105.8 ± 51.9 vs. 54.5 ± 37.7, P < 0.001). As a result, frontal QRS-T angle was independently associated with NRP in ACS patients (P < 0.001) and predicted NRP with a cut-off value of 73.0, 71.7% sensitivity and 70.3% specificity in ROC-Curve analysis (AUC: 0.802, 95% CI: 0.731–0.873, P < 0.001). CONCLUSION: In our research, we observed that the frontal QRS-T angle was an independent predictor of NRP in the ACS patient group. We believe this may be particularly important in the treatment of NRP, early detection of high-risk patients, and improvement of prognosis through appropriate measures. CLINICAL TRIAL REGISTRATION: Not applicable.