Author Affiliations: Departments of Medicine (Dr Estes) and Cardiac Arrhythmia Service (Dr Salem), Tufts University School of Medicine, New England Medical Center Hospital, Boston, Mass.
Of the 5 million
individuals evaluated for acute chest pain syndromes in the United
States annually, approximately 900,000 people develop an acute
myocardial infarction (MI). Rapid and accurate identification of
patients with MI who would benefit from acute reperfusion therapy with
either fibrinolysis or primary percutaneous transluminal coronary
angioplasty remains a major clinical challenge. Despite guidelines for
initial management that emphasize prompt identification, evaluation,
and therapy, reperfusion treatments are substantially
underused.1,2 Since the benefit of reperfusion is greatest
when it is initiated early in the course of an MI, the
electrocardiogram (ECG) remains the single immediately available and
universally used diagnostic test on which the critical decision to
attempt to restore blood flow to the jeopardized myocardium is based.
In this issue of THE JOURNAL, 2 studies analyze
the predictive value of the presenting ECG for outcomes in acute chest
pain syndromes.3,4 Each article provides useful information
on the predictive and prognostic value, clinical utility, and
limitations of the presenting ECG.
Estes III NAM, Salem DN. Predictive Value of the Electrocardiogram in Acute Coronary Syndromes. JAMA. 1999;281(8):753-754. doi:10.1001/jama.281.8.753