The Role of the ECG in Diagnosis, Risk Estimation, and Catheterization Laboratory Activation in Patients with Acute Coronary Syndromes: A Consensus Document

Research output: Contribution to journalReview article


The electrocardiogram (ECG) is the most widely used imaging tool helping in diagnosis and initial management of patients presenting with symptoms compatible with acute coronary syndrome. Acute ischemia affects the configuration of the QRS complexes, the ST segments and the T waves. The ECG should be read along with the clinical assessment of the patient. ST segment elevation (and ST depression in leads V-1-V-3) in patients with active symptoms usually indicates acute occlusion of an epicardial artery with ongoing transmural ischemia. These patients should be triaged for emergent reperfusion therapy per current guidelines. However, many patients have ST segment elevation secondary to nonischemic causes. ST depression in leads other than V-1-V-3 usually are indicative of subendocardial ischemia secondary to subocclusion of the epicardial artery, distal embolization to small arteries or spasm supply/demand mismatch. ST depression may also be secondary to nonischemic etiologies, such as left ventricular hypertrophy, cardiomyopathies, etc. Knowing the clinical scenario, comparison to previous ECG and subsequent ECGs (in cases that there are changes in the quality or severity of symptoms) may add in the diagnosis and interpretation in difficult cases. This review addresses the different ECG patterns, typically seen in patients with active symptoms, after resolution of symptoms and the significance of such changes when seen in asymptomatic patients.


  • Yochai Birnbaum
  • Kjell Nikus
  • Paul Kligfield
  • Miguel Fiol
  • Jose Antonio Barrabes
  • Alessandro Sionis
  • Olle Pahlm
  • J. Garcia Niebla
  • Antonio Bayes de Luna
Research areas and keywords

Subject classification (UKÄ) – MANDATORY

  • Cardiac and Cardiovascular Systems


  • noninvasive techniqueselectrocardiography, Acute coronary syndrome, ischemia, ST elevation, ST depression, myocardial infarction
Original languageEnglish
Pages (from-to)412-425
JournalAnnals of Noninvasive Electrocardiology
Issue number5
Publication statusPublished - 2014
Publication categoryResearch