The early diagnosis and treatment of non-ST-segment elevation acute ischemic syndromes: the need for a new approach.

The diagnosis and treatment of ST-segment elevation myocardial infarction (MI) has been well defined by many multicenter trials. However, the treatment and diagnosis of non-ST-segment elevation MI is much less understood. Single photon emission computerized tomographic perfusion imaging shows great promise in risk-stratifying patients into low-risk and high-risk subsets when 12-lead ECG and initial cardiac enzymes are normal or nondiagnostic. Early exercise stress testing may be important in further risk-stratifying patients whose chest pain has resolved or who have low risk perfusion scans in the emergency department. The role of two-dimensional echocardiography in non-ST-segment elevation MI is currently under investigation.