Normal ECG

Among patients in the ED who had normal ECGs (ie, lacking Q waves; primary ST-segment and T-wave abnormalities; and criteria for non-diagnostic abnormalities), 1% [34] to 6% [82] had AMI. Among admitted patients who had normal ECGs, 6% to 21% had AMI [12,78,81-83]. Of patients discharged home with a normal ECG, only 1% had acute infarction [82]. Patients who have a normal ECG and a suggestive clinical presentation still have a significant risk for ACI, especially if the ECG was obtained when the patient was pain free. On the other hand, a truly normal ECG in a patient unlikely to have acute ischemia provides strong evidence against ACS [34].

In their series, Pope and colleagues [2] found that patients who had normal ST-segment and T waves and no Q waves more commonly had a final diagnosis of non-ACS, yet 20% of these patients had AMI and 37% had UAP at final diagnosis.

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