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J Electrocardiol. 2013 Nov-Dec;46(6):653-9. doi: 10.1016/j.jelectrocard.2013.06.020. Epub 2013 Jul 26.

Pitfalls in diagnosing ST elevation among patients with acute myocardial infarction.

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Baylor College of Medicine, Houston, TX, USA.



Patients with ST elevation (STE) in ≥ 2 leads or ST depression (STD) confined to V₁-V₄ are defined as potential STE myocardial infarction (STEMI). We evaluated the incidence of missed STEMI over an 11-month period.


Consecutive patients with a discharge diagnosis of non STEMI were retrospectively evaluated. Clinical data, ECG and angiographic data were reviewed.


Of the 198 patients screened, 140 were included. Forty-nine patients (35%) met the STEMI criteria: 6 (12%) had STD confined to V₁-V₃, 20 (41%) had STD in V₁-V₆, 7 (14%) had STE in V₁-V₃, 2 (4%) had STE in I and aVL, 11 (22%) had STE in inferior leads, and 6 (12%) had STE in V₄-V₆.


A significant percentage of patients met STEMI ECG criteria. A large number of patients with STD in V₁-V₆ had angiographic evidence compatible with inferolateral (posterior) STEMI equivalent.


Acute coronary syndromes (ACS); Electrocardiogram; Posterior myocardial infarction; Right bundle branch block; ST elevation; ST-elevation myocardial infarction (STEMI)

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