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Background:  Few studies have characterized electrocardiography (ECG) patterns correlated with left ventricular (LV) systolic dysfunction in patients with non-ST segment elevation acute coronary syndrome (NSTE-ACS).   Objectives:  This study aims to develop ECG pattern-derived scores to predict LV systolic dysfunction in NSTE-ACS patients.   Methods:  A total of 466 patients with NSTE-ACS were retrospectively enrolled. LV ejection fraction (LVEF) was assessed by echocardiography within 72 h after the first triage ECG acquisition; there was no coronary intervention in between. ECG score was developed to predict LVEF &amp;lt; 40%. Performance of LVEF, the Global Registry of Acute Coronary Events (GRACE), Thrombolysis in Myocardial Infarction (TIMI) and ECG scores to predict 24-month all-cause mortality were analyzed. Subgroups with varying LVEF, GRACE and TIMI scores were stratified by ECG score to identify patients at high risk of mortality.   Results:  LVEF &amp;lt; 40% was present in 20% of patients. We developed the PQRST score by multivariate logistic regression, including  p oor R wave progression,  Q RS duration &amp;gt; 110 ms, heart  r ate &amp;gt; 100 beats per min, and  ST- segment depression ≥ 1 mm in ≥ 2 contiguous leads, ranging from 0 to 6.5. The score had an area under the curve (AUC) of 0.824 in the derivation cohort and 0.899 in the validation cohort for discriminating LVEF &amp;lt; 40%. A PQRST score ≥ 3 could stratify high-risk patients with LVEF ≥ 40%, GRACE score &amp;gt; 140, or TIMI score ≥ 3 regarding 24-month all-cause mortality.   Conclusions:  The PQRST score could predict LVEF &amp;lt; 40% in NSTE-ACS patients and identify patients at high risk of mortality in the subgroups of patients with LVEF ≥ 40%, GRACE score &amp;gt; 140 or TIMI score ≥ 3.

Electrocardiography Score for Left Ventricular Systolic Dysfunction in Non-ST Segment Elevation Acute Coronary Syndrome