Related Experiment Videos
Serial electrocardiograms for chest pain patients with initial nondiagnostic electrocardiograms: implications for
S H Silber1, P J Leo, M Katapadi
1Department of Emergency Medicine, New York Methodist Hospital, Brooklyn 11215, USA.
Insights
A significant minority of acute myocardial infarction (AMI) patients without initial ST-segment elevation develop it later in the hospital. This highlights the need for serial ECG monitoring in chest pain patients to identify those eligible for thrombolytic therapy.
Area of Science:
- Cardiology
- Emergency Medicine
- Internal Medicine
Background:
- Acute myocardial infarction (AMI) is a leading cause of mortality.
- Early identification of AMI is crucial for timely reperfusion therapy.
- ST-segment elevation on electrocardiogram (ECG) is a key indicator for thrombolytic therapy eligibility.
Purpose of the Study:
- To determine the incidence of ST-segment elevation development in AMI patients initially without ST-segment elevation.
- To compare demographic and clinical features across AMI subgroups based on initial and in-hospital ECG findings.
- To assess the implications for in-hospital management and treatment strategies.
Main Methods:
- Retrospective cohort analysis of chest pain patients diagnosed with AMI.
- Review of initial and serial ECG interpretations.
- Analysis of patient demographics, cardiac risk factors, and in-hospital outcomes.
Main Results:
- Of 94 AMI patients without initial ST-segment elevation, 19 (20%) developed criteria for thrombolytic therapy.
- Late ST-segment elevation occurred at various time points, with male gender and smoking history associated with delayed changes.
- All patients with late diagnostic ECG changes survived to hospital discharge.
Conclusions:
- A substantial proportion of AMI patients develop ST-segment elevation after initial presentation, warranting further monitoring.
- Standardized in-hospital serial ECG protocols may improve the identification of patients eligible for reperfusion therapy.
- Close attention to patients with delayed ST-segment elevation is essential for optimal AMI management.
Objectives:
To determine the proportion of acute myocardial infarction (AMI) patients without ST-segment elevation who subsequently develop ST-segment elevation during their hospital courses; and to compare demographics and presenting features of AMI patient subgroups: those with initial ST-segment elevation, those with in-hospital ST-segment elevation, and those with no ST-segment elevation.
Methods:
A retrospective cohort analysis of admitted chest pain patients who had a hospital discharge diagnosis of AMI was performed. Each chart was examined for initial ECG interpretation, serial ECG analysis, patient age, gender, cardiac risk factors, in-hospital survival, time between sequential ECGs, and number of ECGs performed within the first 48 hours of hospital admission.
Results:
Of the 114 charts reviewed, 20 patients had ECGs meeting thrombolytic criteria on arrival. Of the 94 AMI patients who had nondiagnostic ECGs on arrival, 19 (20%) subsequently developed ECG changes meeting thrombolytic criteria. Seven patients developed these changes within eight hours of the initial ECG, four from eight to 12 hours after, two from 12 to 24 hours after, and six more than 24 hours after. Most patients who had documented AMIs did not develop ECG criteria for thrombolytic therapy during their hospitalizations. Male gender and smoking history were more commonly associated with late ST-segment elevation for those presenting with nondiagnostic ECGs. All the patients who had late diagnostic ECG changes survived to hospital discharge. Serial ECGs were performed more frequently in the group who had initially diagnostic ECGs and least frequently in the group who did not develop ST-segment elevation during their hospitalizations.
Conclusions:
Most patients with AMI do not meet ECG criteria for the administration of thrombolytic therapy. A significant minority (20%) of the admitted chest pain patients with subsequently confirmed AMIs developed ECG criteria for thrombolytics during their hospitalizations. Further attention to such patients who have delayed ST-segment elevation is warranted. A standardized in-hospital serial ECG protocol should be considered to identify admitted patients who develop criteria for thrombolytic or other coronary revascularization therapy.