Use of electrocardiogram indices of myocardial ischemia for risk stratification and decision making of reperfusion strategies

After about a century since its clinical introduction, the 12-lead electrocardiogram (ECG) remains a cornerstone in diagnosis and management of acute ST-elevation myocardial infarction (STEMI). It provides clinicians and researchers with invaluable information regarding the presence, location, and extent of myocardial infarction. Moreover the ECG contains a wealth of prognostic information useful in risk stratification of STEMI patients and identification of particular subgroups that may benefit from more aggressive therapeutic interventions. New data suggest the ECG may be useful in guiding the choice of reperfusion treatment when primary percutaneous coronary intervention (PCI) cannot be delivered in the timeframe recommended by current STEMI guidelines. This paper summarizes the role of the ECG in assessing the baseline risk of patients with STEMI and evaluates the use of ECG indices in decision making of reperfusion strategies.