ST-elevation and non-ST-elevation acute coronary syndromes: should the guidelines be changed?

The 12 lead surface electrocardiogram (ECG) is an indispensable tool to identify acute coronary syndromes and the patient at high risk. Acute coronary syndromes are classified according to the presence or absence of ST elevation (ST Elevation Myocardial Infarction or Acute Coronary Syndrome, STEMI or STEACS and Non ST Elevation Myocardial Infarction). NonSTEMI or nonSTEACS is approached by less invasive and frequently delayed treatment strategies. Because also nonSTEACS comprises severe and/or extensive coronary artery disease undertreatment may occur of these patient categories. Therefore better identification of those patients is needed. In the current guidelines the ischemic ECG changes are incompletely described. Improved description and understanding of the ECG in ACS will lead to better recognition of the patient at risk by emergency physicians and cardiologists.