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Mixon TA, Suhr E, Caldwell G, Greenberg RD, Colato F, Blackwell J, Jo CH, Dehmer GJ. Retrospective Description and Analysis of Consecutive Catheterization Laboratory ST-Segment Elevation Myocardial Infarction Activations With Proposal, Rationale, and Use of a New Classification Scheme. Circ Cardiovasc Qual Outcomes 2012; 5:62-9. [DOI: 10.1161/circoutcomes.111.961672] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Affiliation(s)
- Timothy A. Mixon
- From the Division of Cardiology (T.A.M., F.C., J.B., G.J.D.), the Department of Emergency Medicine (E.S., R.D.G.), the Cardiac Catheterization Laboratory (G.C.), and the Department of Research and Statistics (C.-H.J.), Scott & White Healthcare, Temple, TX
| | - Eunice Suhr
- From the Division of Cardiology (T.A.M., F.C., J.B., G.J.D.), the Department of Emergency Medicine (E.S., R.D.G.), the Cardiac Catheterization Laboratory (G.C.), and the Department of Research and Statistics (C.-H.J.), Scott & White Healthcare, Temple, TX
| | - Gerald Caldwell
- From the Division of Cardiology (T.A.M., F.C., J.B., G.J.D.), the Department of Emergency Medicine (E.S., R.D.G.), the Cardiac Catheterization Laboratory (G.C.), and the Department of Research and Statistics (C.-H.J.), Scott & White Healthcare, Temple, TX
| | - Robert D. Greenberg
- From the Division of Cardiology (T.A.M., F.C., J.B., G.J.D.), the Department of Emergency Medicine (E.S., R.D.G.), the Cardiac Catheterization Laboratory (G.C.), and the Department of Research and Statistics (C.-H.J.), Scott & White Healthcare, Temple, TX
| | - Fernando Colato
- From the Division of Cardiology (T.A.M., F.C., J.B., G.J.D.), the Department of Emergency Medicine (E.S., R.D.G.), the Cardiac Catheterization Laboratory (G.C.), and the Department of Research and Statistics (C.-H.J.), Scott & White Healthcare, Temple, TX
| | - Jeffry Blackwell
- From the Division of Cardiology (T.A.M., F.C., J.B., G.J.D.), the Department of Emergency Medicine (E.S., R.D.G.), the Cardiac Catheterization Laboratory (G.C.), and the Department of Research and Statistics (C.-H.J.), Scott & White Healthcare, Temple, TX
| | - Chan-Hee Jo
- From the Division of Cardiology (T.A.M., F.C., J.B., G.J.D.), the Department of Emergency Medicine (E.S., R.D.G.), the Cardiac Catheterization Laboratory (G.C.), and the Department of Research and Statistics (C.-H.J.), Scott & White Healthcare, Temple, TX
| | - Gregory J. Dehmer
- From the Division of Cardiology (T.A.M., F.C., J.B., G.J.D.), the Department of Emergency Medicine (E.S., R.D.G.), the Cardiac Catheterization Laboratory (G.C.), and the Department of Research and Statistics (C.-H.J.), Scott & White Healthcare, Temple, TX
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Rokos IC, French WJ, Mattu A, Nichol G, Farkouh ME, Reiffel J, Stone GW. Appropriate cardiac cath lab activation: optimizing electrocardiogram interpretation and clinical decision-making for acute ST-elevation myocardial infarction. Am Heart J 2010; 160:995-1003, 1003.e1-8. [PMID: 21146650 DOI: 10.1016/j.ahj.2010.08.011] [Citation(s) in RCA: 102] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2010] [Accepted: 08/12/2010] [Indexed: 12/28/2022]
Abstract
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.
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Affiliation(s)
- Ivan C Rokos
- UCLA-Olive View, Department of Emergency Medicine, Los Angeles, CA, USA.
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