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.jpg): Failed to open stream: No such file or directory in C:\Inetpub\vhosts\kidney.de\httpdocs\pget.php on line 117 Neth+Heart+J
2014 ; 22
(11
): 484-90
Nephropedia Template TP
gab.com Text
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English Wikipedia
Role of the ECG in initial acute coronary syndrome triage: primary PCI regardless
presence of ST elevation or of non-ST elevation
#MMPMID25200324
IJkema BB
; Bonnier JJ
; Schoors D
; Schalij MJ
; Swenne CA
Neth Heart J
2014[Nov]; 22
(11
): 484-90
PMID25200324
show ga
The major initial triaging decision in acute coronary syndrome (ACS) is whether
or not percutaneous coronary intervention (PCI) is the primary treatment. Current
guidelines recommend primary PCI in ST-elevation ACS (STEACS) and initial
antithrombotic therapy in non-ST-elevation ACS (NSTEACS). This review probes the
question whether this decision can indeed be based on the ECG. Genesis of
STE/NSTE ECGs depends on the coronary anatomy, collateral circulation and site of
the culprit lesion. Other causes than ischaemia may also result in ST-segment
changes. It has been demonstrated that the area at risk cannot reliably be
estimated by the magnitude of the ST change, that complete as well as incomplete
occlusions can cause STE as well as NSTE ECGs, and that STE and NSTE patterns
cannot differentiate between transmural and non-transmural ischaemia.
Furthermore, unstable angina can occur with STE and NSTE ECGs. We conclude that
the ECG can be used to assist in detecting ischaemia, but that
electrocardiographic STE and NSTE patterns are not uniquely related to distinctly
different pathophysiological mechanisms. Hence, in ACS, primary PCI might be
considered regardless of the nature of the ST deviation, and it should be done
with the shortest possible delay, because 'time is muscle'.