Volume 7, Issue 4, April – 2022 International Journal of Innovative Science and Research Technology ISSN No:-2456-2165 IJISRT22APR1520 www.ijisrt.com 544 Relationship Between P Wave Peak Time in Leads II And V1 with Syntax Scores to Measure Severity of Coronary Lessions on Non-ST Segment Elevation Acute Myocardial Infarction Patients in Adam Malik Hospital Medan Juang Idaman Zebua 1 , Andika Sitepu 1 , Abdul Halim Raynaldo 1 , Harris Hasan 1 , T. Bob Haykal 1 , Hilfan Ade Putra Lubis 1 1 Department of Cardiology and Vascular Medicine, Faculty of Medicine, University of North Sumatra, Medan, Indonesia Abstract:- Introduction: Non-ST Segment Elevation Acute Myocardial Infarction (NSTEMI) is one of the spectrums of Acute Coronary Syndrome (ACS) with a high mortality rate. Patients with NSTEMI require early risk stratification to define invasive strategy. Electrocardiography (ECG) has been proven useful for detecting cardiac abnormalities due to ACS. One of the ECG parameters used is the P wave peak time. The severity of myocardial ischemia or infarction is determined by the lesion of coronary artery and can be measured based on the SYNTAX score. This study aimed to determine the relationship between the P wave peak time and the SYNTAX score. Method: This is a cross-sectional study of NSTEMI patients who underwent angiography at the Adam Malik Hospital from July 2020 to June 2021. Measurements of P wave peak time on ECG were made in leads II and V1. The SYNTAX score was calculated based on the results of the angiography. Bivariate analysis was conducted to assess the correlation between the two variables. Then, ROC analysis was performed to assess the wave peak time as a predictor of coronary lesion severity. Result: Total subjects were 60 NSTEMI patients consist of 37 (61.66%) patients with severe coronary lesions (SYNTAX score < 23) and 23 (38.33%) patients with non- severe coronary lesions (SYNTAX score  23). There is a moderate positive correlation between the P wave peak time and the SYNTAX score in lead II (r = 0.449; p < 0.001) and in lead V1 (r = 0.405; p = 0.001). Based on ROC analysis, the P wave peak time can predict the severity of coronary lesions with AUC = 0.71 in lead II and AUC = 0.68 in lead V1. Conclusion: The P wave peak time on the ECG has a correlation with the SYNTAX score and can predict the severity of coronary lesions in NSTEMI patients. Keywords:- NSTEMI, P Wave, SYNTAX Score, Coronary Lesion. I. INTRODUCTION Cardiovascular disease is a group of disorders of the heart and blood vessels. According to the World Health Organization (WHO), this disease is the leading cause of death worldwide, with more than any other cause each year. It is estimated that around 17.9 million people died from cardiovascular disease in 2016. This number represents 31% of all global deaths. From this percentage, 85% of deaths were caused by heart attacks due to coronary heart disease and stroke (WHO, 2019). Acute Coronary Syndrome (ACS) which is part of CHD is a major cardiovascular problem because it causes high hospitalization rates and high mortality rates (Irmalita et al , 2015, 2018). ACS is a life-threatening condition and can occur suddenly in patients with atherosclerotic coronary artery disease. This syndrome consists of a range of conditions ranging from unstable angina pectoris (APTS) to widespread acute myocardial infarction (AMI), which is irreversible necrosis of heart muscle (Rhee et al , 2015; Wilder et al , 2016) . The occurrence of ACS is caused by an acute disturbance of coronary blood flow, both partial and total, to the myocardium. ACS consists of unstable angina pectoris (APTS), ST segment elevation non-acute myocardial infarction (IMANEST), and ST segment elevation acute myocardial infarction (IMAEST) (Kim et al , 2013). IMANEST which is one part of SKA is different in each n countries. The Euro Heart Survey, a study based in 25 countries, showed an IMANEST incidence of 58% with a mortality during hospitalization of 2.8% (Hasdai et al , 2002). Meanwhile, based on the CRUSADE (Can Rapid Risk Stratification of Unstable Angina Patients Suppress ADverse Outcomes with Early Implementation of the ACC/AHA Guidelines) registry, the mortality rate during treatment at IMANEST is 4.2% (Widimsky et al , 2007). Even higher mortality rates are shown from the Global Registry of Acute Coronary Events (GRACE) study, which is 5% during treatment and increases after 6 months of treatment, reaching 6.2%-7.3% (Fox et al , 2002; Widimsky et al , 2007). Terkelsen et al (2005) showed the 1-year mortality rate in IMANEST patients was 30.5% with a more advanced age