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The value of the ECG for decision-making at first medical contact in the patient with acute chest pain.
MedLine Citation:
PMID:  20657675     Owner:  NLM     Status:  PubMed-not-MEDLINE    
Abstract/OtherAbstract:
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 identification of those in need of a PCI. In most patients with bundle branch block, previous CABG or PCI, the ECG can not localise the culprit lesion. This approach simplifies and accelerates decision-making at first medical contact. (Neth Heart J 2010;18:301-6.).
Authors:
A Meissner; H J Trappe; M J de Boer; A P Gorgels; H J Wellens
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Netherlands heart journal : monthly journal of the Netherlands Society of Cardiology and the Netherlands Heart Foundation     Volume:  18     ISSN:  1876-6250     ISO Abbreviation:  Neth Heart J     Publication Date:  2010 Jun 
Date Detail:
Created Date:  2010-07-26     Completed Date:  2011-07-14     Revised Date:  2013-05-29    
Medline Journal Info:
Nlm Unique ID:  101095458     Medline TA:  Neth Heart J     Country:  Netherlands    
Other Details:
Languages:  eng     Pagination:  301-6     Citation Subset:  -    
Affiliation:
Marienhospital Herne, Med Klinik II, Ruhr University, Herne, Germany.
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