ECG
STEMI criteria & STEMI equivalents
Checks J-point ST elevation against the ESC 2023 and fourth universal definition thresholds (including posterior and right-sided leads), then lists the STEMI equivalents that warrant cath-lab activation without classic ST elevation, and the high-risk patterns that call for urgent angiography.
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Patient
The V2–V3 threshold depends on sex and age
ST elevation at the J point
New STE in ≥ 2 contiguous leads (ESC 2023 / fourth universal definition)
STEMI equivalents and high-risk patterns
Acute coronary occlusion patterns that do not meet classic ST-elevation criteria
STEMI & STEMI equivalents
Enter ST elevation or select the ECG patterns present.
References
- Byrne RA, et al. 2023 ESC Guidelines for the management of acute coronary syndromes. Eur Heart J 2023;44:3720-3826.
- Thygesen K, et al. Fourth universal definition of myocardial infarction (2018). Circulation 2018;138:e618-e651.
- de Winter RJ, et al. A new ECG sign of proximal LAD occlusion. N Engl J Med 2008;359:2071-2073.
- de Zwaan C, Bär 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;103:730-736.
- Aslanger E, et al. A new electrocardiographic pattern indicating inferior myocardial infarction. J Electrocardiol 2020;61:41-46.
- Khan AR, et al. Impact of total occlusion of culprit artery in acute non-ST elevation myocardial infarction: a systematic review and meta-analysis. Eur Heart J 2017;38:3082-3089.
- Littmann L. South African flag sign: a teaching tool for easier ECG recognition of high lateral infarct. Am J Emerg Med 2016;34:107-109.