The value of the ECG for decision-making at first medical contact in the patient with acute chest pain.

Netherlands Heart Journal : Monthly Journal of the Netherlands Society of Cardiology and the Netherlands Heart Foundation
A MeissnerH J Wellens

Abstract

Background/Objectives. Rapid risk stratification of the patient with acute chest pain is essential to select the best management. We investigated the value of the ECG at first medical contact to determine size of the ischaemic myocardial area and thereby severity of risk.Methods. In 386 patients with acute chest pain, ECG findings were correlated with the coronary angiogram. Using ST-segment deviation patterns the location of the coronary culprit lesion was predicted and thereby size of the area at risk. Four groups of patients were present. Those with a narrow QRS and a total 12-lead ST-segment deviation score of >/=5 mm (group 1) or </=4 mm (group 2); a QRS width of >/=120 ms (group 3), and patients with previous coronary bypass grafting (CABG) or percutaneous coronary intervention (PCI) (group 4).Results. Correct coronary culprit lesion localisation was possible in 84% of the 185 patients in group 1, 40% of the total cohort. Accurate prediction was not possible in most patients in groups 2, 3 and 4, in spite of extensive coronary artery disease in group 3 and 4. Conclusions. Using the 12-lead ECG the size of the myocardial area at risk can be accurately predicted when the total ST-segment deviation score is >/=5 mm, allowing...Continue Reading

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Citations

Sep 10, 2014·Netherlands Heart Journal : Monthly Journal of the Netherlands Society of Cardiology and the Netherlands Heart Foundation·B B L M IJkemaC A Swenne
Sep 9, 2015·Medizinische Klinik, Intensivmedizin und Notfallmedizin·H-J Trappe
May 10, 2017·EuroIntervention : Journal of EuroPCR in Collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology·Rob EerdekensNils P Johnson
Oct 30, 2019·BMC Cardiovascular Disorders·Abdulsalam AlkaiyatNizar Shakhshir

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