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

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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 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.)

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    A. Meissner

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  1. A. Meissner
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  2. A. P. Gorgels
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  3. H. J. Wellens
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Marienhospital Herne, Med Klinik II, Ruhr University, Herne, Germany

Department of Cardiology, Isala Clinics, Zwolle, the Netherlands

Department of Cardiology, Academic Hospital, Maastricht, the Netherlands

Cardiovascular Research Institute, Maastricht, the Netherlands

H.J. Wellens 21 Henric van Veldekeplein, 6211 TG Maastricht, the Netherlands

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Meissner, A., Gorgels, A.P. & Wellens, H.J. The value of the ECG for decision-making at first medical contact in the patient with acute chest pain . NHJL 18, 301–306 (2010). https://doi.org/10.1007/BF03091780

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