ST-Segment Deviation Analysis of the Admission 12-Lead Electrocardiogram as an Aid to Early Diagnosis of Acute Myocardial Infarction With a Cardiac Magnetic Resonance Imaging Gold Standard

Abstract

In patients admitted to hospital with possible AMI, the consideration of both ST-segment elevation and depression in the standard 12 lead-ECG recording significantly increases the sensitivity for the detection of AMI with only a slight decrease in the specificity.

Strain Echocardiography and Wall Motion Score Index Predicts Final Infarct Size in Patients With Non–ST-Segment–Elevation Myocardial Infarction

“…As this and other studies show, a subgroup of NSTEMI patients have substantial infarction, 5,6 and there is a significant overlap in final infarct size between STEMI and NSTEMI patients. 6 Even patients with a normal ECG my develop large infarctions. 5 The latter corresponds to our findings, as only 7 of 13 patients (54%) with infarct size Ն12% had any evidence of ischemia in the ECG.…”

“…ST-segment elevation in the ECG has high specificity but suboptimal sensitivity for detection of MI and acute coronary occlusion 3 and has demonstrated only modest correlation to infarct size. 4 A number of patients with non-ST-segment-elevation MI (NSTEMI) have substantial infarction, 5,6 but these patients rarely fulfill criteria for acute reperfusion therapy. In current clinical practice, no instant method for early assessment of final infarct size in patients with NSTEMI exists.…”

Urgent Myocardial Revascularization in Non ST-Segment Elevation Acute Myocardial Infarction Guided by Speckle Tracking Echocardiography: A Challenging Interventional Decision-Making

“…According to this, it has been repeatedly shown that some NSTEMI patients may have a substantial infarction [2,6,7]. Also, some authors showed a significant overlap in the final infarct size between STEMI and NSTEMI patients [7] and others documented that even NSTEMI patients with a normal ECG at presentation may develop large infarctions [6]. On this basis, NSTEMI patients who have a substantial infarction should be promptly identified.…”

ST-Segment Elevation Interpretation on Electrocardiogram

“…Both tracings depicted not only ST-segment elevation but also reciprocal ST-segment deviation, a finding reported to increase the sensitivity of MI detection on ECG. 1 The differential diagnosis for ST-segment elevation is broad, and includes pulmonary embolism, pericarditis, myocarditis, hyperkalemia, acute aortic dissection, pancreatitis, Brugada syndrome, gallbladder disease, antidepressant drug overdose, cardiac tumors, recent electrical cardioversion, or implantable cardioverter defibrillator shocks. 2 It is imperative to correlate the patient's clinical presentation with ECG findings when evaluating patients with chest pain or acute ST-segment abnormalities suggestive of acute ischemic ensure accurate diagnosis.…”