Sökmen, ErdoğanYıldırım, Alp2025-10-012025-10-012025SN: 2757-6655 / 2757-6655https://hdl.handle.net/20.500.12451/14583Background: Frontal and spatial QRS-T angles reflect ventricular repolarization heterogeneity and may be associated with coronary artery disease severity. This study aimed to evaluate their relationship with SYNTAX and Gensini scores in non-ST elevation myocardial infarction (NSTMI) patients. Methods: A total of 1188 patients with NSTMI were retrospectively analyzed. Frontal and spatial QRS-T angles were calculated from 12-lead digital ECGs using the Rautaharju method. Correlation, univariate and multivariate linear regression, ROC, and logistic regression analyses were performed to assess their associations with SYNTAX and Gensini scores. Results: The spatial QRS-T angle was independently associated with SYNTAX and Gensini scores in multivariate linear regression, whereas the frontal QRS-T angle showed no significant association. Patients with SYNTAX score >32 had significantly higher spatial QRS-T angles. ROC analysis demonstrated that spatial QRS-T angle >105.2° predicted high SYNTAX scores with an AUC of 0.80. Logistic regression confirmed the spatial angle as an independent predictor of high SYNTAX score (OR: 1.04, 95% CI: 1.02–1.06; p<0.001). Conclusion: The spatial QRS-T angle, but not the frontal angle, is a significant independent predictor of severe coronary artery disease in NSTMI patients. It may serve as a simple, non-invasive ECG marker for identifying patients with high atherosclerotic burden.eninfo:eu-repo/semantics/openAccessNon-ST Elevation Myocardial InfarctionSpatial QRS-T angleFrontal QRS-T AngleSYNTAX ScoreGensini ScoreArticle53103113