When should a non-STEMI be treated with primary PCI as for STEMIs?

Wong, Cheuk‐Kit

doi:10.1016/j.ijcard.2012.05.063

Cited by 4 publications

(2 citation statements)

References 15 publications

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“…Abortion of STEMI before hospitalization should also be tested as the new treatment goal, at least theoretically an increasingly achievable target given the ongoing advances in antiplatelet and anticoagulant medications. Currently, cath-lab activation for STEMI has a false activation rate of approximately 11% [5]. Phone-internet-ECG approach may ensure the earliest activation, although this will increase false-positive rates.…”

Section: What About Right Bundle Branch Block?mentioning

confidence: 99%

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Reperfusion therapy for ST-segment elevation myocardial infarction: has ECG information been underutilized?

Wong

2014

Expert Review of Cardiovascular Therapy

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This perspective makes a contentious viewpoint that ECG information is underutilized in ST-segment elevation myocardial infarction (STEMI) and the next breakthrough rests on its full utilization. This is to better diagnose difficult cases such as ST changes during bundle branch block, posterior ST elevation and right-sided ST elevation during normal conduction, and aVR ST elevation. More importantly, this is to better characterize the STEMI for tailored reperfusion. The proposal is to develop a system capable of recording from multiple electrodes that one can apply onto oneself, and having analysis coordinated centrally via phone-internet transmission. This provides 'longitudinal' in addition to 'cross-sectional' ECG information. STEMI will be classified on a gray-scale according to its potential size and speed of Q wave evolution. The hypothesis is that large rapidly progressive STEMI is best treated by on-site fibrinolysis with prompt transferral to a percutaneous coronary intervention center; while small stuttering STEMI is best treated by primary percutaneous coronary intervention despite a long delay.

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Section: What About Right Bundle Branch Block?mentioning

confidence: 99%

“…If the ST elevation fails to meet the STEMI criteria despite an acute total coronary occlusion, the consequent ongoing transmural infarction (STEMI equivalent) is masquerading as a non-STEMI and likely managed without timely reperfusion [5]. Even for the 'straightforward ST-elevation' cases, important questions remain: Can the STEMI diagnosis be made earlier?…”

mentioning

confidence: 99%