Skip to main content
SpringerLink
Log in

The Role of ECG in the Diagnosis and Risk Stratification of Acute Coronary Syndromes: an Old but Indispensable Tool

  • Management of Acute Coronary Syndromes (H Jneid, Section Editor)
  • Published:
Current Cardiology Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

Since its inception in 1902 by Willem Einthoven, the electrocardiogram (ECG) has fundamentally undergone minimal technological advances. Nevertheless, its clinical utility is critical, and it remains an essential tool to diagnose, risk stratify, and guide reperfusion and invasive strategies in patients with suspected acute coronary syndromes. ECG reading can be demanding, with many healthcare professionals lacking the necessary expertise to accurately interpret them. This is exacerbated by the need to constantly revisit old dogmas pertinent to the interpretation of ECGs.

Recent Findings

Notably, ECG leads record the global electrical activity of the heart toward and away from each electrode rather than local events. The long-held central paradigm that the various ECG leads record local events underneath specific electrodes should therefore be reassessed. For example, ST segment elevation in leads V1 and V2 usually denote antero-apical rather than septal infarction, often a misnomer utilized by the majority of clinicians. The ECG diagnosis of ST-elevation myocardial infarction (STEMI) is sometimes challenging and discerning it from non-ST-elevation myocardial infarction (NSTEMI) is of paramount importance to implement timely acute reperfusion therapy. In fact, when qualifications for emergency reperfusion therapy are based on STEMI ECG criteria, nearly one-third of cases with acute coronary occlusion are missed. Diagnostic ST elevation in the absence of left ventricular (LV) hypertrophy or left bundle-branch block (LBBB) is defined by a specific set of sex-specific criteria for new ST elevation at the J point in contiguous precordial or limb leads. However, other ECG criteria need to be kept in mind. These include, but are not limited to, new or presumably new left bundle branch block (LBBB), which is often considered as an STEMI-equivalent; ST depression in two or more precordial leads (V1–V4), denoting a true inferolateral transmural myocardial infarction; and the infrequent presentation with hyperacute T-wave changes.

Summary

As our understanding of the pathology of ischemic reperfusion injury has evolved and following the introduction of new imaging modalities such as cardiac magnetic resonance imaging, we need to re-assess the old dogmas pertinent to the interpretation of ECGs and update the terms and classifications.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Einthoven W. Galvanometrische registratie van het menschelijk electrocardiogram. In: Herrineringsbundel, Prof. S. Rosenstein. Leiden: Eduard Ijdo, Netherlands: 1902:107.

  2. •• Thygesen K, Alpert JS, Jaffe AS, Chaitman BR, Bax JJ, Morrow DA, et al. Fourth universal definition of myocardial infarction (2018). Eur Heart J. 2019;40(3):237–69. https://doi.org/10.1093/eurheartj/ehy462. (The manuscript describes new paradigms and terminology for acute coronary syndromes.)

    Article  Google Scholar 

  3. Ibanez B, James S, Agewall S, Antunes MJ, Bucciarelli-Ducci C, Bueno H, et al. 2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation: the Task Force for the management of acute myocardial infarction in patients presenting with ST-segment elevation of the European Society of Cardiology (ESC). Eur Heart J. 2018;39(2):119–77. https://doi.org/10.1093/eurheartj/ehx393.

    Article  PubMed  Google Scholar 

  4. O’Gara PT, Kushner FG, Ascheim DD, Casey DE Jr, Chung MK, de Lemos JA, et al. ACCF/AHA guideline for the management of ST-elevation myocardial infarction: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Circulation. 2013;127(4):e362-425. https://doi.org/10.1161/CIR.0b013e3182742cf6.

    Article  PubMed  Google Scholar 

  5. • Aslanger EK, Meyers PH, Smith SW. STEMI: A transitional fossil in MI classification? J Electrocardiol. 2021;65:163–9. https://doi.org/10.1016/j.jelectrocard.2021.02.001. (The manuscript describes the distinction between STEMI and acute occlusion of coronary artery infarction.)

    Article  PubMed  Google Scholar 

  6. • Pendell Meyers H, Bracey A, Lee D, Lichtenheld A, Li WJ, Singer DD, et al. Accuracy of OMI ECG findings versus STEMI criteria for diagnosis of acute coronary occlusion myocardial infarction. Int J Cardiol Heart Vasc. 2021;33: 100767. https://doi.org/10.1016/j.ijcha.2021.100767. (The manuscript describes the low sensitivity of ST elevation in detecting acute occlusion of coronary arteries.)

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  7. •• Indications for fibrinolytic therapy in suspected acute myocardial infarction: collaborative overview of early mortality and major morbidity results from all randomised trials of more than 1000 patients. Fibrinolytic Therapy Trialists' (FTT) Collaborative Group. Lancet. 1994;343(8893):311–22.(This manuscript is the foundation for reperfusion therapy in patients with ST elevation myocardial infarction.)

  8. •• Birnbaum Y, Levine GN, French J, Kaski JC, Atar D, Alam M, et al. Inferior ST-elevation myocardial infarction presenting when urgent primary percutaneous coronary intervention is unavailable: should we adhere to current guidelines? Cardiovasc Drugs Ther. 2020;34(6):865–70. https://doi.org/10.1007/s10557-020-07039-0. (This manuscript describes the lack of evidence supporting class I recommendation for reperfusion therapy in patients with inferior STEMI.)

    Article  PubMed  PubMed Central  Google Scholar 

  9. Zeymer U, Huber K, Fu Y, Ross A, Granger C, Goldstein P, et al. Impact of TIMI 3 patency before primary percutaneous coronary intervention for ST-elevation myocardial infarction on clinical outcome: results from the ASSENT-4 PCI study. Eur Heart J Acute Cardiovasc Care. 2012;1(2):136–42. https://doi.org/10.1177/2048872612447069.

    Article  PubMed  PubMed Central  Google Scholar 

  10. De Luca G, Ernst N, Zijlstra F, van 't Hof AW, Hoorntje JC, Dambrink JH et al. Preprocedural TIMI flow and mortality in patients with acute myocardial infarction treated by primary angioplasty. J Am Coll Cardiol. 2004;43(8):1363–7. https://doi.org/10.1016/j.jacc.2003.11.042.

  11. •• Deshpande A, Birnbaum Y. ST-segment elevation: distinguishing ST elevation myocardial infarction from ST elevation secondary to nonischemic etiologies. World J Cardiol. 2014;6(10):1067–79. https://doi.org/10.4330/wjc.v6.i10.1067. (This manuscript describes the differential diagnosis of ST elevation.)

    Article  PubMed  PubMed Central  Google Scholar 

  12. •• Huang HD, Birnbaum Y. ST elevation: differentiation between ST elevation myocardial infarction and nonischemic ST elevation. J Electrocardiol. 2011;44(5):494 e1- e12. https://doi.org/10.1016/j.jelectrocard.2011.06.002.(This manuscript describes the differential diagnosis of ST elevation.)

  13. • de Luna AB, Zareba W, Fiol M, Nikus K, Birnbaum Y, Baranowski R, et al. Negative T wave in ischemic heart disease: a consensus article. Ann Noninvasive Electrocardiol. 2014;19(5):426–41. https://doi.org/10.1111/anec.12193. (This manuscript describes the current understanding of the significance of T wave inversion in patients with suspected acute coronary syndromes.)

    Article  PubMed  PubMed Central  Google Scholar 

  14. Dowdy L, Wagner GS, Birnbaum Y, Clemmensen P, Fu Y, Maynard C, et al. Aborted infarction: the ultimate myocardial salvage. Am Heart J. 2004;147(3):390–4. https://doi.org/10.1016/j.ahj.2003.10.008.

    Article  PubMed  Google Scholar 

  15. Birnbaum Y, Fiol M, Nikus K, Niebla JG, Bacharova L, Dubner S, et al. A counterpoint paper: comments on the electrocardiographic part of the 2018 Fourth Universal Definition of Myocardial Infarction. J Electrocardiol. 2020;60:142–7. https://doi.org/10.1016/j.jelectrocard.2020.04.012.

    Article  PubMed  Google Scholar 

  16. Atar S, Barbagelata A, Birnbaum Y. Electrocardiographic diagnosis of ST-elevation myocardial infarction. Cardiol Clin. 2006;24(3):343–65, vii. https://doi.org/10.1016/j.ccl.2006.04.008.

  17. Sadanandan S, Hochman JS, Kolodziej A, Criger DA, Ross A, Selvester R, et al. Clinical and angiographic characteristics of patients with combined anterior and inferior ST-segment elevation on the initial electrocardiogram during acute myocardial infarction. Am Heart J. 2003;146(4):653–61. https://doi.org/10.1016/S0002-8703(03)00369-7.

    Article  PubMed  Google Scholar 

  18. Arbane M, Goy JJ. Prediction of the site of total occlusion in the left anterior descending coronary artery using admission electrocardiogram in anterior wall acute myocardial infarction. Am J Cardiol. 2000;85(4):487–91, A10.https://doi.org/10.1016/s0002-9149(99)00777-8.

  19. Birnbaum Y, Sclarovsky S, Solodky A, Tschori J, Herz I, Sulkes J, et al. Prediction of the level of left anterior descending coronary artery obstruction during anterior wall acute myocardial infarction by the admission electrocardiogram. Am J Cardiol. 1993;72(11):823–6. https://doi.org/10.1016/0002-9149(93)91071-o.

    Article  CAS  PubMed  Google Scholar 

  20. Birnbaum Y, Solodky A, Herz I, Kusniec J, Rechavia E, Sulkes J, et al. Implications of inferior ST-segment depression in anterior acute myocardial infarction: electrocardiographic and angiographic correlation. Am Heart J. 1994;127(6):1467–73. https://doi.org/10.1016/0002-8703(94)90372-7.

    Article  CAS  PubMed  Google Scholar 

  21. Engelen DJ, Gorgels AP, Cheriex EC, De Muinck ED, Ophuis AJ, Dassen WR, et al. Value of the electrocardiogram in localizing the occlusion site in the left anterior descending coronary artery in acute anterior myocardial infarction. J Am Coll Cardiol. 1999;34(2):389–95. https://doi.org/10.1016/s0735-1097(99)197-7.

    Article  CAS  PubMed  Google Scholar 

  22. Allencherril J, Fakhri Y, Engblom H, Heiberg E, Carlsson M, Dubois-Rande JL, et al. The significance of ST-elevation in aVL in anterolateral myocardial infarction: an assessment by cardiac magnetic resonance imaging. Ann Noninvasive Electrocardiol. 2018;23(6): e12580. https://doi.org/10.1111/anec.12580.

    Article  PubMed  PubMed Central  Google Scholar 

  23. Birnbaum Y, Hasdai D, Sclarovsky S, Herz I, Strasberg B, Rechavia E. Acute myocardial infarction entailing ST-segment elevation in lead aVL: electrocardiographic differentiation among occlusion of the left anterior descending, first diagonal, and first obtuse marginal coronary arteries. Am Heart J. 1996;131(1):38–42. https://doi.org/10.1016/s0002-8703(96)90048-4.

    Article  CAS  PubMed  Google Scholar 

  24. Sclarovsky S, Birnbaum Y, Solodky A, Zafrir N, Wurzel M, Rechavia E. Isolated mid-anterior myocardial infarction: a special electrocardiographic sub-type of acute myocardial infarction consisting of ST-elevation in non-consecutive leads and two different morphologic types of ST-depression. Int J Cardiol. 1994;46(1):37–47. https://doi.org/10.1016/0167-5273(94)90115-5.

    Article  CAS  PubMed  Google Scholar 

  25. Vasudevan K, Manjunath CN, Srinivas KH, Prabhavathi, Davidson D, Kumar S et al. Electrocardiographic localization of the occlusion site in left anterior descending coronary artery in acute anterior myocardial infarction. Indian Heart J. 2004;56(4):315–9.

  26. Allencherril J, Fakhri Y, Engblom H, Heiberg E, Carlsson M, Dubois-Rande JL, et al. Correlation of anteroseptal ST elevation with myocardial infarction territories through cardiovascular magnetic resonance imaging. J Electrocardiol. 2018;51(4):563–8. https://doi.org/10.1016/j.jelectrocard.2018.03.016.

    Article  PubMed  Google Scholar 

  27. Porter A, Wyshelesky A, Strasberg B, Vaturi M, Solodky A, Imbar S, et al. Correlation between the admission electrocardiogram and regional wall motion abnormalities as detected by echocardiography in anterior acute myocardial infarction. Cardiology. 2000;94(2):118–26. https://doi.org/10.1159/000047303.

    Article  CAS  PubMed  Google Scholar 

  28. Huang HD, Tran V, Jneid H, Wilson JM, Birnbaum Y. Comparison of angiographic findings in patients with acute anteroseptal versus anterior wall ST-elevation myocardial infarction. Am J Cardiol. 2011;107(6):827–32. https://doi.org/10.1016/j.amjcard.2010.10.070.

    Article  PubMed  Google Scholar 

  29. Tamura A, Kataoka H, Nagase K, Mikuriya Y, Nasu M. Clinical significance of inferior ST elevation during acute anterior myocardial infarction. Br Heart J. 1995;74(6):611–4. https://doi.org/10.1136/hrt.74.6.611.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  30. Sasaki K, Yotsukura M, Sakata K, Yoshino H, Ishikawa K. Relation of ST-segment changes in inferior leads during anterior wall acute myocardial infarction to length and occlusion site of the left anterior descending coronary artery. Am J Cardiol. 2001;87(12):1340–5. https://doi.org/10.1016/s0002-9149(01)01549-1.

    Article  CAS  PubMed  Google Scholar 

  31. Fiol M, Carrillo A, Rodriguez A, Pascual M, Bethencourt A, Bayes de Luna A. Electrocardiographic changes of ST-elevation myocardial infarction in patients with complete occlusion of the left main trunk without collateral circulation: differential diagnosis and clinical considerations. J Electrocardiol. 2012;45(5):487–90. https://doi.org/10.1016/j.jelectrocard.2012.05.001.

  32. Yamaji H, Iwasaki K, Kusachi S, Murakami T, Hirami R, Hamamoto H et al. Prediction of acute left main coronary artery obstruction by 12-lead electrocardiography. ST segment elevation in lead aVR with less ST segment elevation in lead V(1). J Am Coll Cardiol. 2001;38(5):1348–54.https://doi.org/10.1016/s0735-1097(01)01563-7.

  33. Birnbaum Y, Sclarovsky S, Mager A, Strasberg B, Rechavia E. ST segment depression in a VL: a sensitive marker for acute inferior myocardial infarction. Eur Heart J. 1993;14(1):4–7. https://doi.org/10.1093/eurheartj/14.1.4.

    Article  CAS  PubMed  Google Scholar 

  34. Birnbaum Y, Wagner GS, Barbash GI, Gates K, Criger DA, Sclarovsky S, et al. Correlation of angiographic findings and right (V1 to V3) versus left (V4 to V6) precordial ST-segment depression in inferior wall acute myocardial infarction. Am J Cardiol. 1999;83(2):143–8. https://doi.org/10.1016/s0002-9149(98)00814-5.

    Article  CAS  PubMed  Google Scholar 

  35. Jia X, Heiberg E, Sejersten Ripa M, Engblom H, Carlsson M, Halvorsen S, et al. Cardiac magnetic resonance evaluation of the extent of myocardial injury in patients with inferior ST elevation myocardial infarction and concomitant ST depression in leads V1–V3: analysis from the MITOCARE Study. Cardiology. 2018;140(3):178–85. https://doi.org/10.1159/000491745.

    Article  PubMed  Google Scholar 

  36. Hasdai D, Birnbaum Y, Herz I, Sclarovsky S, Mazur A, Solodky A. ST segment depression in lateral limb leads in inferior wall acute myocardial infarction. Implications regarding the culprit artery and the site of obstruction. Eur Heart J. 1995;16(11):1549–53. https://doi.org/10.1093/oxfordjournals.eurheartj.a060776.

  37. Jia X, Heiberg E, Ripa MS, Engblom H, Halvorsen S, Arheden H, et al. Correlation of ST changes in leads V4–V6 to area of ischemia by CMR in inferior STEMI. Scand Cardiovasc J. 2018;52(4):189–95. https://doi.org/10.1080/14017431.2018.1458145.

    Article  PubMed  Google Scholar 

  38. Assali AR, Sclarovsky S, Herz I, Adler Y, Porter A, Solodky A, et al. Comparison of patients with inferior wall acute myocardial infarction with versus without ST-segment elevation in leads V5 and V6. Am J Cardiol. 1998;81(1):81–3. https://doi.org/10.1016/s0002-9149(97)00808-4.

    Article  CAS  PubMed  Google Scholar 

  39. Koivula K, Konttila KK, Eskola MJ, Martiskainen M, Huhtala H, Virtanen VK, et al. Long-term outcome of pre-specified ECG patterns in acute coronary syndrome. J Electrocardiol. 2020;62:178–83. https://doi.org/10.1016/j.jelectrocard.2020.08.001.

    Article  PubMed  Google Scholar 

  40. Nikus KC, Eskola MJ, Virtanen VK, Vikman S, Niemela KO, Huhtala H, et al. ST-depression with negative T waves in leads V4–V5–a marker of severe coronary artery disease in non-ST elevation acute coronary syndrome: a prospective study of Angina at rest, with troponin, clinical, electrocardiographic, and angiographic correlation. Ann Noninvasive Electrocardiol. 2004;9(3):207–14. https://doi.org/10.1111/j.1542-474X.2004.93545.x.

    Article  PubMed  PubMed Central  Google Scholar 

  41. Kosuge M, Ebina T, Hibi K, Morita S, Endo M, Maejima N, et al. An early and simple predictor of severe left main and/or three-vessel disease in patients with non-ST-segment elevation acute coronary syndrome. Am J Cardiol. 2011;107(4):495–500. https://doi.org/10.1016/j.amjcard.2010.10.005.

    Article  PubMed  Google Scholar 

  42. Collet JP, Thiele H, Barbato E, Barthelemy O, Bauersachs J, Bhatt DL, et al. 2020 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation. Eur Heart J. 2021;42(14):1289–367. https://doi.org/10.1093/eurheartj/ehaa575.

    Article  PubMed  Google Scholar 

  43. Knotts RJ, Wilson JM, Kim E, Huang HD, Birnbaum Y. Diffuse ST depression with ST elevation in aVR: Is this pattern specific for global ischemia due to left main coronary artery disease? J Electrocardiol. 2013;46(3):240–8. https://doi.org/10.1016/j.jelectrocard.2012.12.016.

    Article  PubMed  Google Scholar 

  44. Gorgels AP, Vos MA, Mulleneers R, de Zwaan C, Bar FW, Wellens HJ. Value of the electrocardiogram in diagnosing the number of severely narrowed coronary arteries in rest angina pectoris. Am J Cardiol. 1993;72(14):999–1003. https://doi.org/10.1016/0002-9149(93)90852-4.

    Article  CAS  PubMed  Google Scholar 

  45. Birnbaum GD, Birnbaum I, Birnbaum Y. Twenty years of ECG grading of the severity of ischemia. J Electrocardiol. 2014;47(4):546–55. https://doi.org/10.1016/j.jelectrocard.2014.02.003.

    Article  PubMed  Google Scholar 

  46. Sagie A, Sclarovsky S, Strasberg B, Kracoff O, Rechavia E, Bassevich R, et al. Acute anterior wall myocardial infarction presenting with positive T waves and without ST segment shift. Electrocardiographic features and angiographic correlation Chest. 1989;95(6):1211–5. https://doi.org/10.1378/chest.95.6.1211.

    Article  CAS  PubMed  Google Scholar 

  47. Zorzi A, Perazzolo Marra M, Migliore F, Tarantini G, Iliceto S, Corrado D. Interpretation of acute myocardial infarction with persistent “hyperacute T waves” by cardiac magnetic resonance. Eur Heart J Acute Cardiovasc Care. 2012;1(4):344–8. https://doi.org/10.1177/2048872612466537.

    Article  PubMed  PubMed Central  Google Scholar 

  48. de Winter RJ, Verouden NJ, Wellens HJ, Wilde AA, Interventional Cardiology Group of the Academic Medical C. A new ECG sign of proximal LAD occlusion. N Engl J Med. 2008;359(19):2071–3.https://doi.org/10.1056/NEJMc0804737.

  49. de Winter RW, Adams R, Amoroso G, Appelman Y, Ten Brinke L, Huybrechts B, et al. Prevalence of junctional ST-depression with tall symmetrical T-waves in a pre-hospital field triage system for STEMI patients. J Electrocardiol. 2019;52:1–5. https://doi.org/10.1016/j.jelectrocard.2018.10.092.

    Article  PubMed  Google Scholar 

  50. Zhan ZQ, Li Y, Han LH, Nikus KC, Birnbaum Y, Baranchuk A. The de Winter ECG pattern: distribution and morphology of ST depression. Ann Noninvasive Electrocardiol. 2020;25(5): e12783. https://doi.org/10.1111/anec.12783.

    Article  PubMed  PubMed Central  Google Scholar 

  51. de Zwaan C, Bar FW, Janssen JH, Cheriex EC, Dassen WR, Brugada P, et al. Angiographic and clinical characteristics of patients with unstable angina showing an ECG pattern indicating critical narrowing of the proximal LAD coronary artery. Am Heart J. 1989;117(3):657–65. https://doi.org/10.1016/0002-8703(89)90742-4.

    Article  PubMed  Google Scholar 

  52. de Zwaan C, Bar FW, Wellens HJ. Characteristic electrocardiographic pattern indicating a critical stenosis high in left anterior descending coronary artery in patients admitted because of impending myocardial infarction. Am Heart J. 1982;103(4 Pt 2):730–6. https://doi.org/10.1016/0002-8703(82)90480-x.

    Article  PubMed  Google Scholar 

  53. Nikus K, Pahlm O, Wagner G, Birnbaum Y, Cinca J, Clemmensen P, et al. Electrocardiographic classification of acute coronary syndromes: a review by a committee of the International Society for Holter and Non-Invasive Electrocardiology. J Electrocardiol. 2010;43(2):91–103. https://doi.org/10.1016/j.jelectrocard.2009.07.009.

    Article  PubMed  Google Scholar 

  54. Patton KK, Ellinor PT, Ezekowitz M, Kowey P, Lubitz SA, Perez M, et al. Electrocardiographic early repolarization: a scientific statement from the American Heart Association. Circulation. 2016;133(15):1520–9. https://doi.org/10.1161/CIR.0000000000000388.

    Article  PubMed  Google Scholar 

  55. Jolobe OMP. Differential diagnosis of the association of gastrointestinal symptoms and ST segment elevation, in the absence of chest pain. Am J Emerg Med. 2021;49:137–41. https://doi.org/10.1016/j.ajem.2021.05.067.

    Article  PubMed  Google Scholar 

  56. Zhan ZQ, Wang CQ, Nikus KC, He CR, Wang J, Mao S, et al. Electrocardiogram patterns during hemodynamic instability in patients with acute pulmonary embolism. Ann Noninvasive Electrocardiol. 2014;19(6):543–51. https://doi.org/10.1111/anec.12163.

    Article  PubMed  PubMed Central  Google Scholar 

  57. Nishi SP, Barbagelata NA, Atar S, Birnbaum Y, Tuero E. Hypercalcemia-induced ST-segment elevation mimicking acute myocardial infarction. J Electrocardiol. 2006;39(3):298–300. https://doi.org/10.1016/j.jelectrocard.2005.10.015.

    Article  PubMed  Google Scholar 

  58. Heckle M, Agarwal M, Alsafwah S. ST Elevations in the setting of hyperkalemia. JAMA Intern Med. 2018;178(1):133–4. https://doi.org/10.1001/jamainternmed.2017.6329.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Section of Cardiology, Department of Medicine, Baylor College of Medicine, One Baylor Plaza, Houston, MS: BCM620, 77030, USA

    Yochai Birnbaum & Hani Jneid

  2. Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland

    Jani Rankinen

  3. Dept. of Cardiology, Institute of Clinical Medicine, Oslo University Hospital Ulleval, University of Oslo, Oslo, Norway, Norway

    Dan Atar

  4. Heart Center, Faculty of Medicine and Health Technology, Tampere University Hospital, Tampere University, Tampere, Finland

    Kjell Nikus

Authors
  1. Yochai Birnbaum
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jani Rankinen
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Hani Jneid
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Dan Atar
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Kjell Nikus
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Yochai Birnbaum.

Ethics declarations

Conflict of Interest

The authors declare that they have no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

This article is part of the Topical Collection on Management of Acute Coronary Syndromes

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Birnbaum, Y., Rankinen, J., Jneid, H. et al. The Role of ECG in the Diagnosis and Risk Stratification of Acute Coronary Syndromes: an Old but Indispensable Tool. Curr Cardiol Rep 24, 109–118 (2022). https://doi.org/10.1007/s11886-021-01628-7

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11886-021-01628-7

Keywords

Search

Navigation