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February 24, 1999

Predictive Value of the Electrocardiogram in Acute Coronary Syndromes

Author Affiliations

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.

JAMA. 1999;281(8):753-754. doi:10.1001/jama.281.8.753

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.