The role of the ECG in the diagnosis and management of acute coronary syndrome

Česká verzia

Authors: P. Schweitzer; R. Kučinský
Authors place of work: Division of Cardiology, Department of Medicine Beth Israel Medical Center, and Mount Sinai Service at Queens Hospital Center, New York, N. Y. USA
Published in the journal: Vnitř Lék 2005; 51(6): 714-717
Category: Reviews

Summary

The classification of acute myocardial ischemic heart disease underwent important evolution. Presently the initial working diagnosis is acute coronary syndrome (ACS), sub classified into ST segment elevation (STE) and non-ST segment elevation (NSTE). Some authors continue to use Q (QMI) and Non Q wave myocardial infarction (NQMI), others consider the differences between them meaningless. Similarly there is no general agreement whether Q and NQMI should be replaced with ST segment elevation (STEMI) and Non-ST elevation segment (NSTEMI) myocardial infarction only as the initial working diagnosis or as the final one. The purpose of this review is to discuss the role of the ECG in the, diagnosis, management and outcome of acute coronary syndrome (ACS), the differences between Q and NQMI and the need to sub classify NSTE ACS.

Key words:
electrocardiography – acute coronary syndrome

Zdroje

1. Gibson R. Non-Q wave myocardial infarction: diagnosis, prognosis and management. In: Current Problems in Cardiology. Chicago: Year Book Medical Publishers 1988; 13: 1–7.

2. Spodick DH. Q-Wave infarction versus S-T infarction; Nonspecificity of electrocardiographic criteria for differentiating transmural and nontransmural lesions. Am J Cardiol 1983; 51: 914–917.

3. Hutter AM, DeSanctis RW, Flynn T et al. Nontransmural myocardial infarction comparison of hospital and late clinical course of patients with that of matched patients with transmural anterior and transmural inferior myocardial infarction. Am J Cardiol 1981; 48: 595–602.

4. Scheinman MM, Abbott JA. Clinical significance of transmural vs. Nontransmural electrocardiographic changes in patients with acute myocardial infarction. Am J Med 1973; 55: 602–607.

5. Schamroth L. The electrocardiology of coronary artery disease. Oxford: Blackwel Scientific publication 1975; 73–77.

6. Prinzmetal M, Shaw CM, Maxwell M et al. Studies on the mechanism of ventricular activity, VI. The depolarization complex in pure subendocardial infarction: role of the subendocardial region in the normal electrocardiogram. Am J Med 1954; 16: 469–488.

7. Savage RM, Wagner GS, Ideker RE et al. Correlation of postmortem anatomical findings with electrocardiographic changes in patients with myocardial infarction. Circulation 1977; 55: 279–258.

8. Pipberger H, Schwartz L, Massumi RA et al. Studies on the mechanism of ventricular activity. XXI. The origin of the depolarization complex with clinical application. Am Heart J 1957; 54: 511–529.

9. Pipberger H, Lopes E. „Silent“ myocardial infarcts; fact or fiction? Am Heart J 1980; 100: 597–599.

10. Phibbs B, Marcus F, Marriott HJC et al. Q-wave versus non-Q-wave myocardial infarction: a meaningless distinction. J Am Coll Cardiol 1999; 33: 576–582.

11. Gorlin R, Fuster V, Ambrose J. Anatomic–physiologic links between acute coronary syndrome. Circulation 1986; 74: 6–9.

12. Hamm CVV, Bertand M, Braunwald E. Acute coronary syndrome without ST elevation: implementation of new guidelines. Lancet 2001; 358: 2533–2538.

13. Braunwald E, Antman EM, Beasley JW et al. ACC/AHA guidelines for the management of patients with unstable angina: report of the American College of Cardiology/American heart Association task force on practice guidelines (Committee on the management of patients with unstable angina). J Am Coll Cardiol 2000; 36: 970–1062.

14. Furman MI, Dauerman HL, Goldberg RJ et al. Twenty-two year (1975 to 1997) trends in the incidence, in-hospital and long-term case fatality rates from initial Q-wave and non-Q-wave myocardial infarction: a multi-hospital, community-wide perspective. J Am Coll Cardiol 2001; 37: 1571–1580.

15. Myocardial infarction redefined – A consensus document of the joint European Society of Cardiology/American College of Cardiology committee for the redefinition of myocardial infarction. Eur Heart J 2000; 21: 1502–1513.

16. Chow C, Yan AT, Yan R et al. Admission and follow-up ECG classification of acute coronary syndromes.

A tale of two systems (ST versus Q wave status). Circulation 2003; 108: 383–384.

17. Hersi A, Fu Y, Wong B et al. Does the discharge ECG provide additional prognostic insight(s) in non–ST elevation ACS patients from that acquired on admission? Eur Heart J 2003; 24: 522–531.

18. Mizuno K, Satomura K, Miyamoto A et al. Angioscopic evaluation of coronary thrombi in acute coronary syndrome. N Engl J Med 1992; 326: 287–291.

19. Brener SJ, Topol EJ. Troponin, embolization and restoration of microvascular integrity. Eur Heart J 2000: 21: 1117–1119.

20. Yang H, Pu M, Rodriguez D et al. Ischemic and viable myocardium in patients with non-Q-wave or Q-wave myocardial infarction and left ventricular dysfunction: a clinical study using positron emission tomography, echocardiography, and electrocardiography. J Am Coll Cardiol 2004; 43: 592–598.

21. The global use of strategies to open occluded coronary arteries (GUSTO–IIb) investigators. A comparison of recombinant hirudin with heparin for the treatment of acute coronary syndromes. N Engl J Med 1996; 335: 775–782.

22. Keeley EC, Boura JA, Grines CL. Primary angioplasty versus intravenous thrombolytic therapy for acute myocardial infarction: a quantitative review of 23 randomized trial. Lancet 2003; 361: 13–20.

23. TIMI IIIB Trial Investigators. Effects of tissue plasminogen activator and a comparison of early invasive and conservative strategy in unstable angina and non-Q-wave myocardial infarction: results of the TIMI IIIB trial. Circulation 1994; 89: 1545–1556.

24. Boden WE, O’Rourke RA, Crawford MH et al. Outcomes in patients with acute non-Q-wave myocardial infarction randomly assigned to an invasive as compared with a conservative management strategy: Veterans Affairs Non-Q-Wave Infarction Strategy in hospital (Van-Qwish) trial investigators. N Engl J Med 1998; 338: 1785–1792.

25. Bavry AA, Kumbhani DJ, Quiroz R et al. Invasive therapy along with Glycoprotein IIb/IIIa inhibitors and intracoronary stent improves survival in non-ST-elevation acute coronary syndromes: A Meta-analysis and review of the literature. Am J Cardiol 2004; 93: 830–835.

26. FRISC-II Investigators. Invasive compared to non-invasive treatment of unstable coronary-artery disease: FRISC II prospective randomized multicenter study. Lancet 1999; 354: 708–715.

27. Armstrong PW, Fu Y, Chang WC et al. Acute coronary syndromes in the GUSTO-IIb trial; Prognostic insights and impact of recurrent ischemia. Circulation 1998; 98: 1860–1868.

28. Cannon CP, McCabe CH, Stone PH et al. The electrocardiogram predicts one-year outcome of patients with unstable angina and non-Q-wave myocardial infarction: results of the TIMI III registry ECG ancillary study. Thrombolysis in myocardial ischemia. J Am Coll Cardiol 1997; 30: 1333–1340.

29. Diderholm E, Andren B, Frostfeldt G et al. ST segment depression in ECG at entry indicates severe coronary lesions and large benefits of an early invasive treatment strategy in unstable coronary artery disease. Eur Heart J 2002; 23: 41–49.

30. Holmvang L, Clemmensen P, Lindahl B et al. Quantitative analysis of the admission electrocardiogram identifies patients with unstable coronary artery disease who benefit the most from early invasive treatment. J Am Coll Cardiol 2003; 41: 905–915.

31. Jacobsen MD, Wagner GS, Holmvang E et al. Clinical significance of abnormal T waves in patients with non-St-segment elevation acute coronary syndrome.

32. Holmvang L, Luscher MS, Clemmensen P et al. Very early risk stratification using combined ECG and biochemical assessment in patients with unstable coronary artery disease (a thrombin inhibition in myocardial infarction (TRIM) substudy). Circulation 1998; 98: 2004–2009.