Abstract

Objective: Coronary artery disease (CAD) remains a significant global health burden, characterized by the narrowing or blockage of coronary arteries. Treatment decisions are often guided by angiography-based scoring systems, such as the Synergy Between Percutaneous Coronary Intervention with Taxus and Cardiac Surgery (SYNTAX) and Gensini scores, although these require invasive procedures. This study explores the potential of electrocardiography (ECG) as a noninvasive diagnostic tool for predicting CAD severity, alongside traditional risk factors. Methods: This retrospective cross-sectional study was conducted on 348 CAD patients who underwent coronary angiography. Demographic data, ECG findings, SYNTAX, and Gensini scores were collected. The association between ECG findings and demographic information with the severity of coronary artery stenosis, as assessed by SYNTAX and Gensini scores, was investigated using SPSS software, version 23. Results: Significant associations were observed between CAD severity and risk factors such as male gender, diabetes mellitus (DM), and smoking. Additionally, certain ECG indicators, including Q waves and ST depression (STD), showed significant correlations with CAD severity, particularly according to the Gensini score. Conclusion: This study underscores the utility of ECG and clinical factors in identifying severe CAD, offering cost-effective diagnostic alternatives to angiography. Integrating various parameters into a single score is crucial in clinical practice, providing a stronger diagnostic and prognostic tool without increasing costs. Further comprehensive studies are warranted to refine risk prediction models and improve CAD management strategies. © The Author(s) 2025.