ORIGINAL ARTICLE

What's the point of ST elevation?

S D Carley¹, R Gamon², P A Driscoll², G Brown³ and P Wallman¹

¹ Manchester Royal Infirmary, UK
² Hope Hospital, Salford, UK
³ University Hospitals of South Manchester, UK

Correspondence to:
Correspondence to:
Dr S D Carley, Department of Emergency Medicine, Manchester Royal Infirmary, Manchester M13 9WL, UK;
s.carley{at}btinternet.com

Objective: The magnitude of ST elevation is a key piece of information in the decision to thrombolyse in acute myocardial infarction. The ability of clinicians to reliably identify ST elevation has not been previously assessed. This study sought to determine the variability in assessment of ST elevation in a group of doctors who commonly prescribe thrombolysis.

Methods: The study was conducted in three large teaching hospitals in Manchester, England. A convenience sample of 63 SHOs and SpRs from emergency and general medicine were recruited. Each was shown three sample ECG complexes. They were asked to identify and quantify the degree of ST elevation. They then indicated the points on the ECG from which they measured ST elevation.

Results: ST elevation was not identified in 12% of cases. Doctors used a wide variety of points on the ST segment to assess elevation, this resulted in a wide variation in the observed magnitude of ST elevation.

Conclusion: No guidance exists on where exactly ST elevation should be measured. This study shows a wide variation in practice. Protocol led thrombolysis decision pathways may be compromised by these findings.

Keywords: electrocardiography; ST segment; interobserver variablility; thrombolysis

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This article has been cited by other articles:

• Winter, R, Willenheimer, R (2004). The incremental value of myocardial contrast echocardiography (MCE) as a bedside decision-making tool in the coronary care unit. Eur J Echocardiogr 5: 149-155 [Full Text]  
• (2002). At what point should ST elevation be measured?. Heart 88: 416-416 [Full Text]