Atypical Electrocardiographic Presentations in Need of Primary Percutaneous Coronary Intervention.

Détails

ID Serval
serval:BIB_AD75F891B5A2
Type
Article: article d'un périodique ou d'un magazine.
Collection
Publications
Institution
Titre
Atypical Electrocardiographic Presentations in Need of Primary Percutaneous Coronary Intervention.
Périodique
The American journal of cardiology
Auteur⸱e⸱s
Tzimas G., Antiochos P., Monney P., Eeckhout E., Meier D., Fournier S., Harbaoui B., Muller O., Schläpfer J.
ISSN
1879-1913 (Electronic)
ISSN-L
0002-9149
Statut éditorial
Publié
Date de publication
15/10/2019
Peer-reviewed
Oui
Volume
124
Numéro
8
Pages
1305-1314
Langue
anglais
Notes
Publication types: Journal Article ; Review
Publication Status: ppublish
Résumé
Early initiation of reperfusion therapy remains the cornerstone of successful management for ST-elevation myocardial infarction (STEMI). Rapid restoration of coronary blood flow relies on prompt recognition of the typical ST-segment elevation on a 12-lead electrocardiogram (ECG)-a surrogate for coronary occlusion or critical stenosis-allowing timely activation of the STEMI protocol cascade, with a major positive impact in mortality and clinical outcomes. However, atypical, very high risk ECG patterns-known as "STEMI equivalents"-are present in 10% to 25% of patients with ongoing myocardial ischemia in need of urgent primary percutaneous coronary intervention. Though briefly mentioned in the current recommendations, structured clinical data on those specific ECG presentations are lacking. By thoroughly searching MEDLINE and EMBASE we conducted a structured review of non-STEMI, albeit very high risk, ECG patterns of acute coronary syndrome, often associated with coronary occlusion or critical stenosis. After screening 997 studies, we identified the following distinct "STEMI equivalent" ECG patterns: Wellens' syndrome, de Winter sign, hyperacute T waves, left bundle branch block-including paced rhythm-and right bundle branch block. For each pattern, a brief summary of the existing evidence, together with the sensitivity, specificity, and positive predictive value-whenever available-are presented. In conclusion, prompt recognition of "STEMI equivalent" ECG patterns is crucial for every physician or paramedic dealing with acute coronary syndrome patients in the emergency department or the prehospital setting, as misinterpretation of those high risk presentations can lead to reperfusion delays and worse outcomes.
Pubmed
Création de la notice
17/09/2019 13:12
Dernière modification de la notice
16/10/2019 5:12
Données d'usage