Prognostic Value of the Admission Electrocardiogram in Acute Coronary Syndromes

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Abstract
The electrocardiogram (ECG) is the most accessible and widely used diagnostic tool for patients arriving at an emergency department with symptoms suggestive of acute myocardial ischemia. Although the presence of acute ischemic changes on the admission ECG has been associated with a higher risk of cardiac events,1 the prognostic implications of the different ECG presentations of acute myocardial ischemia remain ill-defined. Investigations of the relationship between the findings on the presenting ECG and outcome have reflected the traditional separation of acute myocardial ischemia into its different nosologic entities of Q-wave myocardial infarction (MI),2 non–Q-wave MI,3 and unstable angina.4-7 However, this approach precludes a comprehensive evaluation of the prognostic value of the presenting ECG.

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