ECG analysis in patients with acute coronary syndrome undergoing invasive management: rationale and design of the electrocardiography sub-study of the MATRIX trial.

Gragnano, Felice; Spedicato, Vanessa; Frigoli, Enrico; Gargiulo, Giuseppe; Di Maio, Dario; Fimiani, Fabio; Fioretti, Vincenzo; Annoiato, Claudia; Cimmino, Michele; Esposito, Fabrizio; Chianese, Salvatore; Scalise, Martina; Fimiani, Luigi; Franzese, Michele; Monda, Emanuele; Schiavo, Alessandra; Cesaro, Arturo; De Michele, Alfonso; Scalise, Renato; Caracciolo, Alessandro; ... (2019). ECG analysis in patients with acute coronary syndrome undergoing invasive management: rationale and design of the electrocardiography sub-study of the MATRIX trial. Journal of electrocardiology, 57, pp. 44-54. Elsevier 10.1016/j.jelectrocard.2019.08.045

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The twelve‑lead electrocardiogram (ECG) has become an essential tool for the diagnosis, risk stratification, and management of patients with acute coronary syndromes (ACS). However, several areas of residual controversies or gaps in evidence exist. Among them, P-wave abnormalities identifying atrial ischemia/infarction are largely neglected in clinical practice, and their diagnostic and prognostic implications remain elusive; the value of ECG to identify the culprit lesion has been investigated, but validated criteria indicating the presence of coronary occlusion in patients without ST-elevation are lacking; finally, which criteria among the multiple proposed, better define pathological Q-waves or success of revascularisation deserve further investigations.


The Minimizing Adverse hemorrhagic events via TRansradial access site and systemic Implementation of AngioX (MATRIX) trial was designed to test the impact of bleeding avoidance strategies on ischemic and bleeding outcomes across the whole spectrum of patients with ACS receiving invasive management. The ECG-MATRIX is a pre-specified sub-study of the MATRIX programme which aims at analyzing the clinical value of ECG metrics in 4516 ACS patients (with and without ST-segment elevation in 2212 and 2304 cases, respectively) with matched pre and post-treatment ECGs.


This study represents a unique opportunity to further investigate the role of ECGs in the diagnosis and risk stratification of ACS patients with or without ST-segment deviation, as well as to assess whether the radial approach and bivalirudin may affect post-treatment ECG metrics and patterns in a large contemporary ACS population.

Item Type:

Journal Article (Original Article)


04 Faculty of Medicine > Department of Cardiovascular Disorders (DHGE) > Clinic of Cardiology
04 Faculty of Medicine > Pre-clinic Human Medicine > CTU Bern

UniBE Contributor:

Spedicato, Vanessa; Frigoli, Enrico; Gargiulo, Giuseppe; Windecker, Stephan and Valgimigli, Marco


600 Technology > 610 Medicine & health








Beatrice Minder Wyssmann

Date Deposited:

09 Sep 2019 17:35

Last Modified:

30 Nov 2020 02:30

Publisher DOI:


PubMed ID:


Additional Information:

Felice Gragnano AND Vanessa Spedicato contributed equally to this work;

Uncontrolled Keywords:

Acute coronary syndromes Atrial infarction ECG Myocardial infarction Percutaneous coronary intervention Radial access




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