Appropriate Cardiac Cath Lab activation: Optimizing electrocardiogram interpretation and clinical decision-making for acute ST-elevation myocardial infarction

During the last few decades, acute ST-elevation on an electrocardiogram (ECG) in the proper clinical context has been a reliable surrogate marker of acute coronary occlusion requiring primary percutaneous coronary intervention (PPCI). In 2004, the American College of Cardiology/American Heart Associ...

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Bibliographic Details
Published in:The American heart journal 2010-12, Vol.160 (6), p.995-1003.e8
Main Authors: Rokos, Ivan C., MD, French, William J., MD, Mattu, Amal, MD, Nichol, Graham, MD, Farkouh, Michael E., MD, MSc, Reiffel, James, MD, Stone, Gregg W., MD
Format: Article
Language:English
Subjects:
Biological and medical sciences
Biomarkers
Cardiac Catheterization
Cardiology. Vascular system
Cardiovascular
Coronary heart disease
Decision making
Decision Making, Computer-Assisted
Electrocardiography
Emergency medical care
Heart
Heart attacks
Humans
Medical imaging
Medical sciences
Myocardial Infarction - diagnosis
Myocardial Infarction - physiopathology
Myocarditis. Cardiomyopathies
Patients
Reproducibility of Results
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Summary:During the last few decades, acute ST-elevation on an electrocardiogram (ECG) in the proper clinical context has been a reliable surrogate marker of acute coronary occlusion requiring primary percutaneous coronary intervention (PPCI). In 2004, the American College of Cardiology/American Heart Association ST-elevation myocardial infarction (STEMI) guidelines specified ECG criteria that warrant immediate angiography in patients who are candidates for primary PPCI, but new findings have emerged that suggest a reappraisal is warranted. Furthermore, as part of integrated and efficient STEMI systems, emergency department and emergency medical services providers are now encouraged to routinely make the time-sensitive diagnosis of STEMI and promptly activate the cardiac catheterization laboratory (Cath Lab) team. Our primary objective is to provide a practical summary of updated ECG criteria for emergency coronary angiography with planned PPCI, thus allowing clinicians to maximize the rate of appropriate Cath Lab activation and minimize the rate of inappropriate Cath Lab activation. We review the evidence for ECG interpretation strategies that either increase diagnostic specificity for “classic” STEMI and left bundle-branch block or improve diagnostic sensitivity in identifying 4 STEMI-equivalents: posterior MI, acute left main occlusion, de Winter ST/T-wave complex, and certain scenarios of resuscitated cardiac arrest.
ISSN:0002-8703
1097-6744
DOI:10.1016/j.ahj.2010.08.011