ST-segment elevation: More than a current of injury

Some ECG guidelines and textbooks treat ischemic ST-segment elevation (STE) as a current of injury. The term dates from the first decades of electrocardiography, when the current of injury was the only available explanation for ischemic ST-segment and T-wave changes. Other theories now explain them as well. A current probably flows across ischemic borders, but it is one mechanism among several, and naming the waveform after one theory favors it without evidence. Ischemia may leave the myocardium injured, but ST elevation is not the marker of that state. The ST segment returns to baseline while stunned myocardium persists. Newer principles of ischemic electrocardiography treat these findings as a continuum of degree, not a sequence of stages, and as surrogates for occlusion myocardial infarction. We give separate names to the myocardial process, the ischemic electrical disturbance, and the surface sign. The surface sign should be described as recorded, in the leads where it appears, and the term "current of injury" should be retired.