title: Pitfalls in diagnosing ST elevation among patients with acute myocardial infarction.
abstract: OBJECTIVE
  Patients with ST elevation (STE) in ≥ 2 leads or ST depression (STD) confined to V₁-V₄ are defined as potential STE myocardial infarction (STEMI). We evaluated the incidence of missed STEMI over an 11-month period.
  
  
  METHODS
  Consecutive patients with a discharge diagnosis of non STEMI were retrospectively evaluated. Clinical data, ECG and angiographic data were reviewed.
  
  
  RESULTS
  Of the 198 patients screened, 140 were included. Forty-nine patients (35%) met the STEMI criteria: 6 (12%) had STD confined to V₁-V₃, 20 (41%) had STD in V₁-V₆, 7 (14%) had STE in V₁-V₃, 2 (4%) had STE in I and aVL, 11 (22%) had STE in inferior leads, and 6 (12%) had STE in V₄-V₆.
  
  
  CONCLUSIONS
  A significant percentage of patients met STEMI ECG criteria. A large number of patients with STD in V₁-V₆ had angiographic evidence compatible with inferolateral (posterior) STEMI equivalent.
authors.affiliation: Baylor College of Medicine, Houston, TX, USA.
authors.forename: Edward Y
authors.initials: EY
authors.lastname: Wei
authors.forename: Ravi S
authors.initials: RS
authors.lastname: Hira
authors.forename: Henry D
authors.initials: HD
authors.lastname: Huang
authors.forename: James M
authors.initials: JM
authors.lastname: Wilson
authors.forename: MacArthur A
authors.initials: MA
authors.lastname: Elayda
authors.forename: Scott R
authors.initials: SR
authors.lastname: Sherron
authors.forename: Yochai
authors.initials: Y
authors.lastname: Birnbaum
mesh_terms: D003951:Diagnostic Errors / Q000517:prevention & control* / Q000706:statistics & numerical data*; D004562:Electrocardiography / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis*; D015203:Reproducibility of Results; D012307:Risk Factors; D012680:Sensitivity and Specificity; D013781:Texas / Q000453:epidemiology
keywords: Acute coronary syndromes (ACS); Electrocardiogram; Posterior myocardial infarction; Right bundle branch block; ST elevation; ST-elevation myocardial infarction (STEMI)