STEMI: Diagnosis

ST-segment elevation myocardial infarction (STEMI) diagnosis is essentially based on three elements: (1) typical chest pain that also represents the clinical counterpart of acute myocardial ischemia onset due to acute coronary occlusion and might be taken as time zero on which all successive delays should be calculated, (2) electrocardiogram (ECG) changes of the ST-T segment that are persistent (> 20 min) and evolve in time whereas they might soon present with a new pathological (> 40 ms duration) Q wave, and (3) critical abnormalities of high sensitivity cardiac troponin of either T or I types that should be higher than certain levels (> 5–14 pg/mL), which represent the respective and recommended upper reference limit. Although it should be important to have these limits measured in relation to the local population, and both gender and age ranges should be considered along with the specific essay used, short-term repetition of cardiac troponin assays may rule out the probability of acute coronary syndromes or confirm the presence of STEMI.