Electrical Risk Score as a Predictor of Coronary Artery Disease

<b>Background/Objectives:</b> Coronary artery disease (CAD) is a leading cause of global mortality, necessitating effective risk stratification tools for optimal patient management. The electrical risk score (ERS) is a multi-parametric index incorporating various electrocardiographic (ECG) parameters, previously shown to predict unfavorable cardiovascular outcomes. However, the relationship between ERS and the presence and severity of CAD remains unclear. This study aimed to investigate the association of ERS with the presence and extent of CAD as assessed by coronary angiography. <b>Methods:</b> This retrospective study included 314 consecutive patients who underwent coronary angiography. ERS was calculated using six ECG parameters: heart rate > 75 bpm, left ventricular hypertrophy, delayed QRS transition zone, frontal QRS-T angle > 90°, prolonged QTc interval, and extended T peak to T end interval. <b>Results:</b> Of the study population (mean age 57.8 ± 11.4, 61.5% male), 158 were diagnosed with CAD, and 156 constituted the control group. The mean ERS was significantly higher in the CAD group than the control group (2.34 ± 1.35 vs. 1.78 ± 1.12, <i>p</i> = 0.006). Among ERS components, delayed QRS transition (<i>p</i> = 0.023), prolonged QTc (<i>p</i> = 0.004), and extended T peak to T end interval (<i>p</i> = 0.001) were notably more prevalent in the CAD group. ERS was independently associated with the presence of CAD on multivariate logistic regression analysis (<i>p</i> < 0.05). <b>Conclusions:</b> ERS is significantly associated with the presence and severity of CAD in stable patients. Elevated ERS, particularly due to delayed QRS transition, prolonged QTc, and extended T peak to T end interval, may serve as a valuable, non-invasive marker for prediction and early identification of CAD.