Contenidos

La ECG en la cardiopatíaisquémica crónica estable

Cambios morfológicos y arritmias (véase el ECG en el infarto   crónico   con   y   sin   «factores   de   confusión») .
Los pacientes con cardiopatía isquémica crónica con o sin IM previo pueden presentar un ECG basal normal o diferentes cambios del QRS (Q de necrosis o QRS fragmentado), y/o del ST/T (ST elevado o descendido) y onda T aplanada/negativa.
Es un signo  de buen  pronóstico que  la T negativa  que aparece después de un infarto Q (cambio postisquémico) desaparezca con el tiempo (Fig. 20.36), pero muy a menudo los cambios de la onda T, e incluso a veces del ST, persisten muchos años. Sobre todo en presencia de descenso del ST, es aconsejable realizar una prueba de esfuerzo.
Finalmente, la persistencia de un ST elevado mucho después de un infarto Q es sospechosa de aneurisma ventricular (Fig. 20.33 C).
A menudo aparecen diferentes tipos de bloqueos ventriculares como consecuencia de la cardiopatía isquémica, lo cual puede ser un signo de mal pronóstico (ver antes).
Respecto a las arritmias (Caps. 14 a 18), la presencia de extrasístoles ventriculares, especialmente frecuentes, y salvas de TV es un marcador de riesgo, sobre todo en presencia de disfunción ventricular (Bayés-Fiol, 2008; Bayés de Luna, 2011). Ya hemos discutido (véase isquemia y MS, y 20.2) la importancia de la isquemia en la fase aguda y crónica de la cardiopatía isquémica en la presentación de arritmias ventriculares malignas y MS. Por último, la incidencia de arritmias auriculares, especialmente de FA, es relativamente frecuente, y es también un marcador de mal pronóstico.
Bibliografía

Abbas A, Boura J, Brewington S, et al. Acute angiographic analysis of NSTE-acute myocardial infarction. Am J Cardiol. 2004;24:907.
Abu-Assi E, García-Acuña JM, Peña-Gil C, et al. Validation of the GRACE risk score for predicting death within 6 months of follow-up in a contemporary cohort of patients with acute coronary syndrome. Rev Esp Cardiol. 2010;63:640.
Aldrich HR, Wagner NB, Boswick J, et al. Use of initial ST-segment deviation for prediction of final electrocardiographic size of acute myocardial infarcts. Am J Cardiol. 1988;61:749–53.
Armstrong E, Kulkarni A, Bhave P, et al. Electrocardiographic criteria for ST-elevation myocardial infarction in patients with left ventricular hypertrophy. Am J Cardiol. 2012;110:977.
Antman EM, Cohen M, Bernink PJ, et al. The TIMI risk score for unstable angina/non-ST elevation MI:  A method  for prognostication  and therapeutic decision  making. JAMA. 2000;284:835.
Antman EM, Anbe D, Amstrong PV, et al. ACC/AHA guidelines for the management of STEMI. J Am Coll Cardiol. 2004;44:21.211.
Barrabes J, Figueras J, Moure C, Cortadellas J, Soler Soler J. Prognostic significanced of ST depression in lateral leads on admission ECG in patients with first acute myocardial infarction. J Am Coll Cardiol. 2000;35:1813.
Bayés de Luna A. Clinical Arrhythmology. Wiley-Blackwell, 2011.
Bayés de Luna A, Fiol M. The Electrocardiography in Ischemic Heart Disease: clinical and imaging correlations and prognostic implications. Futura-Blackwell, 2008.
Bayés de Luna A, Carreras F, Cladellas, et al. Holter ECG study of the electrocardiographic phenomena in Prinzmetal angina attacks with emphasis on the study of ventricular arrhythmias. J Electrocardiol. 1985;18:267.
Bayés de Luna A, Coumel Ph, Leclercq JF. Ambulatory sudden cardiac death: mechanism of the basis of fatal arrhythmais from 157 cases. Am Heart J. 1989;117:151.
Bayés de Luna A, Cino JM, Pujadas S, et al. Concordance of electrocardiograhpic patterns and healed myocardial infarction locaton detected by cardiovascular magnetic resonance. Am J Cardiol. 2006a;97:443.
Bayés de Luna A, Wagner G, Birnbaum Y, et al. A new terminology for the left ventricular walls and for the location of myocardial infarcts that present Q wave based on the standard of cardiac magnetic resonance imaging. A statement for healthcare professionals from a committee appointed by the International Society for Holter and Non Invasive Electrocardiography. Circulation. 2006b;114:1755.
Bayés de Luna A, Cino J, Goldwasser D, et al. New electrocardiographic diagnostic criteria for the pathologic R waves in leads V1 and V2 of anatomically lateral myocardial infarction. J Electrocardiol. 2008;41:413.
Ben-Gal T, Herz I, Solodky A, et al. Acute anterior wall myocardial infarction entailing ST elevation in V1: electrocardiographic  and  angiographic  correlations.  Clin  Cardiol.   1998;21:399.
Benchimol A, Desser KB, Schumacher J. Value of the vectorcardiogram for distinguishing left anterior hemiblock from inferior infarction with left axis deviation. Chest. 1972;61:74.
Birnbaum Y,  Atar S.  Electrocardiogram risk  stratification of  non ST  elevation acutecoronary syndrome. J Electrocardiol. 2006;39:558.
Birnbaum Y, Sclarovsky S, Blum, et al. Prognostic significance of the initial electrocardiographic pattern in a first acute anterior wall myocardial infarction. Chest. 1993;103:1681.
Birnbaum Y, Zhou S, Wagner GS. New considerations of ST segment “elevation” and “depression” and accompanying T wave configuration in acute coronary syndromes. J Electrocardiol. 2011;44:1.
Birnbaum Y, Bayés de Luna A, Fiol M, et al. Common pitfalls in the interpretation of electrocardiograms from patients with acute coronary syndromes with narrow QRS: a consensus report. J of Electrocardiology. 2012;42:463.
Björklund E, Stenestrand U, Lindbäck J, et al. RIKS-HIA Investigators. Prehospital diagnosis and start of treatment reduces time delay and mortality in real-life patients with STEMI. J Electrocardiol. 2005;38:186.
Bouwmeester S, van Hellemond I, Maynard Ch, et al. The stability of the ST segment estimation of myocardial area at risk between the prehospital and hospital electrocardiograms in patients with ST elevation myocardial infarction. J Electrocardiol. 2011;44:363.
Braunwald‘s Heart diseases. A Textbook of  Cardiovascular  Medicine.  Elsevier Saunders Pub.,  2012.
Burke A, Farb A, Malcom GT, et al. Coronary risk factors and plaque morphology in men with coronary disease who die suddenly. N Engl J Med. 1997;336:1276.
Cannon CP. Management of Acute Coronary Syndromes. Humana Press, 2003.
Cannon RP, Braunwald  E.  Unstable  angina.  In:  Braunwald-Zipes Libby.  Heart  diseases 6th  Edition.  Saunders,  2001.
Carrillo A, Fiol M, García-Niebla J, et al. Electrocardiographic differential diagnosis between Takotsubo syndrome and distal occlusion of LAD is not easy. J Am Coll Cardiol. 2010;56:1610.
Choi WS, Lee JH, Park SH, et al. Prognostic value of standard electrocardiographic parameters for predicting major adverse cardiac events after acute myocardial infarction. Ann Noninvasive Electrocardiol. 2011;16:56.
Cino JM, Pujadas S, Carreras F., et al. Utility of contrast-enhanced cardiovascular magnetic resonance (CE-CMR) to assess how likely is an infarct to produce a typical ECG pattern. Journal of Cardiovascular Magnetic Resonance. 2006;8:335.
Cohen M, Scharpf SJ, Rentrop KP. Prospective analysis of electrocardiographic variables as markers for extent and location of acute wall motíon abnormalities observed  during coronary angioplasty in human subjects. J Am Coll Cardiol. 1987;10:17. Correale E, Sattista R, Ricciardíello V, et al. The negative U wave: apathogenetic enigma but a useful, often overlooked bedside diagnostic and prognostic clue in ischemic heart disease. Clin Cardiol. 2004;27:674.
Das MK, Khan B, Jacob S, et al. Significance of a fragmented QRS complex versus a Q wave in patients with coronary artery disease. Circulation. 2006;113:2495.
De Vreede-Swagemakers JJ, Gorgels  AP,  Dubois-Arbouw  WI,  et  al.  Out-of-hospital  cardiac arrests in the 1990s: a population based study in the Maastricht area on incidence,  characteristics  and  survival.  J  Am  Coll  Cardiol.  1997;30:1500.
De Winter RJ, Verouden NJ, Wellens HJ, et al. Interventional Cardiology Group of the Academic Medical Center. A new ECG sign of proximal LAD occlusion. N Engl J Med.   2008;359:2071.
De Zwan C, Bär H, Wellens HJ. Characteristic ECG pattern indicating a critical stenosis high in left anterior descending coronary artery in patients admitted because of an impending infarction. Am Heart J. 1982;103:730.
Dellborg, M, Topol, EJ, Swedberg, K., et al. Dynamic QRS complex and ST segment vectorcardiographic monitoring can identify vessel patency in patients with acute myocardial infarction treated with reperfusion therapy. Am Heart J. 1991;122:943.
Dixon W. Anatomic distribution of the culprit lesion in patients with NSTE-ACS undergoing PCI. J Am Coll Cardiol. 2008;62:1347.
Doevendans PA, Gorgels AP, van der Zee R, et al. Electrocardiographic diagnosis of reperfusion during thrombolytic therapy in acute myocardial infarction. Am J Cardiol. 1995;75:1206.
Dressler W, Roesler H. High T waves in the earliest stage of myocardial infarction. Am Heart  J.  1947;34:627.
Durrer D, Van Dam R, Freud G, et al. Total excitation of the isolated human heart. Circulation.  1970;41:899.
Eagle K, Lim M, Dabbous O., et al. for the GRACE Investigators. A validated prediction model for allf orms of acute coronary syndrome. Estimating the rist of 6-month postdischarge death in an international registry. JAMA. 2004;291:2727.
East, T, Oran, S. The ECG in ventricular aneurysm following acute infarction. Br Heart J. 1952;14:125.
Elsman P, Van’t Hof AW, de Boer MJ, et al. Impact of infarct location on left ventricular ejection fraction after correction for enzymatic infarct size in acute myocardial infarction treated with primary coronary intervention. Am Heart J. 2006;151:1239.
Engelen DJ, Gorgels AP, Cheriex EC, et al. Value of the electrocardiogram in localizing the occlusion site in the left anterior descending coronary artery in acute anterior myocardial infarction. J Am Coll Cardiol. 1999;34:389.
Finn A, Antman E. Images in clinical medicine: Isolated right ventricular infarction. N Engl J Med. 2003;349:17.
Fiol M, Barcena JP, Rota JI, et al. Sustained ventricular tachycardia as a marker of inadequate myocardial perfusion during the acute phase of myocardial infarction. Clin Cardiol. 2002;25:328.
Fiol M, Cygankiewicz I, Bayés Genis A, et al. The value of ECG algorithm based on ‘ups and downs’ of ST in assessment of a culprit artery in evolving inferior myocardial infarction. Am J Cardiol. 2004;94:709.
Fiol M, Carrillo A, Cygankiewicz I, et al. A new electrocardiographic algorithm to locate the occlusion in left anterior descending coronary artery. Clin Cardiol. 2009;32:E1–6.
Fiol M, Carrillo A, Bayés de Luna A, et al. ST-elevation as ECG pattern in case of total occlusion  of  left  main  trunk:  study  of  9  consecutive  cases  (submitted).
Fleischmann KE, Zègre-Hemsey J, Drew BJ. The new universal definition of myocardial infarction criteria improve electro cardiographic diagnosis of acute coronary syndrome. J Electrocardiol. 2011; 44(1):69.
Fox KA, Dabbous OH, Goldberg RJ, et al. Prediction of risk of death and myocardial infarction in the six months after presentation with acute coronary syndrome: prospective multinational observational study (GRACE). BMJ. 2006;333:1091.
From A, Best P, Lennon R, et al. Acute myocardial infarction due to left circumflex artery occlusion and significance of ST-segment elevation. Am J Cardiol. 2010;106:1081.
FTT (Fibrinolytic Therapy Trialists) Collaborative Group. Indications for fibrinolytic therapy in suspected acute myocardial infarction: collaborative overview of early mortality and major morbidity results from all randomised trials of more than 1000 patients.  Lancet.  1994;343:311.
Fuster V, Topol E. Atherosclerosis and Coronary Artery Disease. Lippincott-Raven, 1996. Gorgels A. Explanation of the ECG in the subendocardial ischemia of the anterior wall of the left ventricle. J Electrocardiol. 2009;42:248.
Gul E, Nikus K. An unusual presentation of left anterior descending artery occlusion: significance of lead aVR and T-wave direction. J Electrocardiol. 2011;44:27.
Hathaway WR, Peterson ED, Wagner GS, et al. Prognostic significance of the initial electrocardiogram in patients with acute myocardial infarction. GUSTO-I Investigators. Global Utilization of Streptokinase and t-PA for Occluded Coronary Arteries. JAMA. 1998;279:387.
Holmvang, L, Clemmensen, P, Wagner, et al. Admission standard electrocardiogram for early risk stratification in patients with unstable coronary artery disease not eligible for acute revascularization therapy: A TRIM substudy. ThRombin Inhibition in Myocardial Infarction. Am Heart J. 1999;137:24.
Huang HD, Tran V, Jneid H, Wilson JM, Birnbaum Y. Comparison of angiographic findings in patients with acute anteroseptal versus anterior wall ST-elevation myocardial infarction.  Am  J  Cardiol.  2011;107:827.
Ibáñez B, Navarro F, Farré J, et al. [Tako-tsubo syndrome associated with a long course of the left anterior descending coronary artery along the apical  diaphragmatic surface of the left ventricle]. Rev Esp Cardiol. 2004;57:209.
Jacobs A. Chair: ACC/AHA Task force members. Unstable angina/ NSTEMI Guidelines revision.  Circulation.  2011:May  3. Jain S, Ting H, Bell M, et al. Utility of left bundle branch block as a diagnostic criterion for acute myocardial infarction. Am J Cardiol. 2011;107:1111.
Janse, M.J. Electrophysiological changes in acute myocardial ischemia. In Julian DG, Lie KI, Wihelmsen L (eds). What is Angina? Astra. 1982, p. 160.
Jayroe JB, Spodick DH, Nikus K, et al. Differentiating ST elevation myocardial infarction and nonishcemic causes of ST elevation by analyzing the presenting electrocardiogram. Am J Cardiol. 2009;103:301.
Jim M-H, Siu C-W, Chan AO-O, et al. Prognostic implications of PR-segment depression in inferior leads in acute inferior myocardial infarction. Clin Cardiol. 2006;29:36. Jimenez-Candil J, Matas JM, Cruz I. In hospital prognosis in NSTEACS using a new risk score based on ECG parameters at entrance. Rev Esp Cardiol 2010;63:851.
Kanei Y, Sharma J, Diwan R, et al. ST segment depression inVR as a predictor of culprit artery in inferior STE-MI. J Electrocardiol. 2010;43:132.
Kaski JC. Pathophysiology and management of patients with chest pain and normal coronary arteriograms (cardiac syndrome X). Circulation. 2004;109:568.
Kaul P, Fu Y, Chang W. Prognostic value of ST depression in ACS: insights from Parangon and GUSTO trials. J Am Coll Cardiol 2001;38:641.
Kenigsberg DN, Khanal S, Kowalski M, et al. Prolongation of the QTc interval is  seen uniformly  during  early  transmural  ischemia.  J  Am  Coll  Cardiol.  2007;49:1299.
Koning R, Cribier A, Korsatz L, et al. Progressive decrease in myocardial ischemia assessed by intracoronary electrocardiogram during successive and prolonged coronary occlusions in angioplasty. Am Heart J. 1993;125:56.
Kosuge M, Ebina T, Hibi K, et al. An early and simple predictor of severe left main and/ or three-vessel disease in patients with non-ST-segment elevation acute coronary syndrome. Am J Cardiol. 2011;107:495.
Larson D, Menssen K, Sharkey S, et al. False positive cardiac catheterization activation among patients with suspected STEMI. JAMA. 2007;298:2754.
Leibrandt PN, Bell SJ, Savona MR, et al. Validation of cardiologist’s decisions to inbitiate reperfusion therapy with ECG viewed on liquid crystal displays of cellular phones Am Heart J. 2000;140:747.
Lie, K.I, Wellens, H.J, Downar, et al. Observations on patients with primary ventricular fibrillation complicating acute myocardial infarction. Circulation. 1975;52:755.
Liu   CK,   Greenspan   G,   Piccirillo   RT.   Atrial   infarction   of   the   heart.   Circulation. 1961;23:331.
Manankil MF, Wang T, Bhat PK. Transient peaked T waves during exercise stress testing: an unusual manifestation of reversible cardiac ischemia. J Electrocardiol. 2011;44:23.
Marcus FI, Cobb LA, Edwards JE, et al. Mechanism of death and prevalence of myocardial ischemic symptoms in the terminal event after acute myocardial infarction. Am J Cardiol. 1988;61:8.
Maseri A, Chierchia S. Coronary vasospasm in ischemic heart disease. Chest. 1980;78:210.
McClelland A, Owens C, Menown I, et al. Comparison of 80 lead body surface map to 12 lead ECG in detection of acute myocardial infarction. Am J Cardiol. 2003;92:252.
Migliore F, Zorzi A, Perazzolo Marra M, et al. Myocardial edema underlies dynamic T-wave inversion (Wellens’ ECG pattern) in patients with reversible left ventricular dysfunction. Heart. Rhythm 2011;8:1629.
Mills JR, Yound E, Gorlin R, et al. The natural history of ST elevation after acute myocardial infarction. Am J Cardiol. 1975;35:609.
Mohlenkamp  S,  Hort,  W,  Ge,  J,  et  al.  Update  on  myocardial  bridging.  Circulation. 2002;106:2616.
Morrow DA, Antman EM, Giugliano RP, et al. A simple risk index for rapid initial triage of patients with ST-elevation myocardial infarction: an InTIME II substudy. Lancet. 2000;358:1571.
Moon JC, De Arenaza DP, Elkington AG, et al. The pathologic basis of Q-wave and nonQ-wave myocardial infarction: a cardiovascular  magnetic  resonance  study  J  Am Coll  Cardiol.  2004;44:554.
Nikus KC, Eskola MJ, Virtanen VK. ST-depression with negative T waves in leads V4–V5-A marker  of  severe  coronary  artery  disease  in  non-ST  elevation  acute  coronary syndrome. A prospective study of angina at rest, with troponin, clinical, electrocardiographic and angiographic correlation. Ann Noninvasive Electrocardiol. 2004;9:207.
Nikus K, Pahlm O, Wagner G, et al. Electrocardiographic classification of acute coronary syndromes: a review by a committee of the International Society for Holter and Non-Invasive Electrocardiology. J Electrocardiol. 2010;43:91.
Nikus K, Pahlm O, Wagner G, et al. Report of the third International Society for Holter and Noninvasive Electrocardiology working group on improved electrocardiographic criteria for acute and chronic ischemic heart disease—Lund, Sweden: June 2010. J Electrocardiol. 2011;44:84.
Oliva Ps, Hammill SC, Edwards WD. Cardiac rupture, a clinically predictable complication of acute myocardial infarction: Report of  70  cases  with  clinicopathologic  correlations. J Am Coll Cardiol. 1993;22:720.
Pascale P, Schlaepfer J, Oddo M, et al. Ventricular arrhythmia in coronary artery disease: limits of a risk stratification strategy based on the ejection fraction alone and impact of infarct localization. Europace. 2009;11:1639.
Petrina M, Goodman SG, Eagle KA. The 12-lead electrocardiogram as a predictive tool of mortality after acute myocardial infarction: current status in an era of revascularization and reperfusion. Am Heart J. 2006;152(1):11.
Pride YB, Tung P, Mohanavelu S, et al. TIMI Study Group. Angiographic and  clinical outcomes among patients with acute coronary  syndromes  presenting  with  isolated anterior ST-segment depression: a TRITON-TIMI 38 (Trial to Assess Improvement in Therapeutic Outcomes by Optimizing Platelet Inhibition With PrasugrelThrombolysis In Myocardial Infarction 38) substudy. JACC Cardiovasc Interv. 2010;3:806.
Prinzmetal M, Kennamer R, Merliss R, et al. Angina pectoris. I. A variant form of angina pectoris; preliminary report. Am J Med. 1959;27:375.
Quyyumi AA, Crake T, Rubens MB, et al. Importance of “reciprocal” electrocardiographic changes during occlusion of left anterior descending artery. Studies during percutaneous transluminal coronary angioplasty. Lancet. 1986;1:347.
Rasouli ML, Ellestad MH. Usefulness of ST depression  in  ventricular  premature  complexes  to  predict  myocardial  ischemia.  Am  J  Cardiol.  2001;87:891.
Reddy CV, Cheriparambill K, Saul B, et al. Fragmented  left  sided  QRS  in  absence  of bundle branch block: sign of left ventricular aneurysm. Ann Noninvasive  Electrocardiol.   2006;11:132.
Reeder GS, Gersh BJ. Modern management of acute myocardial infarction. Curr Probl Cardiol. 2000;25:677.
Reinig MG, Harizi R, Spodick OH. Electrocardiographic Tand U-wave discordance. Ann Noninvasive  Electrocardiol.  2005;10:41.
Roig S, Gómez JA, Fiol M, et al. Spontaneous coronary artery dissection causing acute coronary syndrome: an early diagnosis implies a good prognosis. Am J Emerg Med. 2003;21:549.
Rovai D, Di Bella G, Rossi G, et al. Q-wave prediction of myocardial infarct location, size and transmural  extent at  magnetic resonance  imaging.  Coron Artery  Dis. 2007;18:381.
Rukshin V, Monakier D, Olshtain-Pops, et al. QT interval in patients with unstable angina and non-Q wave myocardial infarction. Noninvasive Electrocardiol. 2002;7:343.
Sagie A, Sclarovsky S, Strasberg B, et al. Acute anterior wall myocardial infarction presenting with positive T waves and without ST segment shift. Electrocardiographic features and angiographic correlation. Chest. 1989;95:1211.
Santoro GM, Valenti R, Buonamici P, et al. Relation between ST-segment changes and myocardial perfusion evaluated by myocardial contrast echocardiography in patients with acute myocardial infarction treated with direct angioplasty. Am J Cardiol. 1998;82:932.
Sasaki K, Yotsukura M, Sakata K, et al. Relation of ST-segment changes in inferior leads during anterior wall acute myocardial infarction to length and occlusion site of the left anterior descending coronary artery. Am J Cardiol. 2001;87:1340.
Savoritto S, Ardissino D, Granger Ch et al. Prognostic value of the admission ECG in ACS. JAMA 1999;281:707.
Sclarovsky S. Electrocardiography of acute coronary syndromes. MartinDunitz Ltd. London, 1995. Selvester RH, Wagner GS, Hindman NB. The Selvester QRS scoring system for estimating myocardial infarct size. The development and application  of  the  system.  Arch Intern  Med.  1985;145:1877.
Sgarbossa EB, Pinski SL, Barbagelata A, et al. Electrocardiographic diagnosis of evolving acute myocardial infarction in the presence of left  bundle  branch block. GUSTO-1 (Global Utilization of Streptokinase and Tissue Plasminogen Activator for Occluded Coronary Arteries) lnvestigators. N Engl J Med. 1996;334:481.
Sherif NE. The rsR’ pattern in left surface leads in ventricular aneurism. Br Heart J.
1970;32:440.
Skinner JS, Smeeth L, Kendall JM, et al. Chest Pain Guideline Development Group. NICE guidance. Chest pain of recent onset: assessment and diagnosis of recent onset chest pain or discomfort of suspected cardiac origin. Heart. 2010;96:974.
Spaulding CM, Joly LM, Rosenberg A, et al. Immediate coronary angiography in survivors of out-of-hospital cardiac arrest. N Engl J Med. 1997;336:1629.
Stankovic I, Ilic I, Panic M, et al. The absence of the ST-segment elevation in acute coronary artery thrombosis: what does not fit, the patient or the explanation?. J Electrocardiol. 2011;44:7.
Stern S, Bayés de Luna A. Coronary spasm: A 2009 update. Circulation. 2009;119:2531.
Subirana MT, Juan-Babot JO, Puig T, et al. Specific characteristics of sudden death in a mediterranean Spanish population. Am J Cardiol. 2011;107:622.
Tamura A, Nagasi KM, Kriya Y, et al. Significance of spontaneous noramlization of negative T wave during healing of anterior myocardial infarction. Am J Cardiol. 1999;84:1341.
Tang EW, Wong CK, Herbison P. Global registry of acute coronary events (GRACE) hospital discharge risk score accurately predicts long-term mortality post acute coronary syndrome. Am Heart J. 2007;154:851.
Tanimoto T, Imanishi T, Kitabata H, et al. Prevalence and clinical significance of papillary muscle infarction detected by late gadolinium-enhanced magnetic resonance imaging in patients with ST-segment elevation myocardial infarction. Circulation. 2010;122:2281.
Teixeira R, Lourenco C, Antonio N. The importance of a normal ECG in NSTE-ACS. Arq Brasileiros  Card.  2010;94:24.
Thygessen K, Alpert JS, White HD; Joint ESC/ACCF/AHA/WHF Task Force for the Redefinition of Myocardial Infarction. Universal definition of myocardial infarction. J Am Coll Cardiol 2012;60:October 16. Tierala I, Nikus KC, Sclarovsky S, et al. Predicting the culprit artery in acute ST elevation MI: Correlation with coronary anatomy in the HAAMU trial. J Electrocardiol. 2009;42:120.
Tjandrawidjaja MC, Fu Y, Westerhout CM, et al.; APEX-AMI Investigators. Resolution of ST-segment depression: A new prognostic marker in ST-segment elevation myocardial  infarction.  Eur  Heart  J.  2010;31:573.
Tomai F, Crea F, Chiariello L, et al. Ischemic preconditioning in humans: models, mediators, and clinical relevance. Circulation. 1999;100:559.
Uyarel H, Cam N, Okmen E, et al. Level of Selvester QRS score is predictive of ST-segment resolution and 30-day outcomes in patients with acute myocardial infarction undergoing primary coronary intervention. Am Heart J. 2006;151:1239.
Van der Weg K, Bekkers SCAM, Winkens B, et al., on behalf of MAST. Evaluation of the electrocardiogram in identifying and quantifying lateral involvement in nonanterior wall infarction using cardiovascular magnetic resonance imaging. J of Electrocardiology. 2012;45:478.
Wellens HJ, Connover HP. The ECG in Emergency Decision-making. WB Saunders Co, 2006. Wellens  HJ,  Gorgels  A,  Doevendans  PA.  The  ECG  in  Acute  Myocardial  Infarction  and Unstable Angina. Kluwer Academic Publishers, 2003. Westerhout C, Fu Y, Lauer M, et al. Short and long term stratification in ACS. J Am Coll Cardiol 2006;48:939.
Widimsky P, Holmes DR Jr. How to treat patients with ST-elevation acute myocardial infarction and multi-vessel disease? Eur Heart J. 2011;32:396.
Wong CK, French JK, Aylward PE, et al. Usefulness of the presenting electrocardiogram in predicting successful reperfusion with streptokinase in acute myocardial infarction. Am J Cardiol. 1999;83:164.
Wong CK, Gao W, Raffel OC, et al. HERO-2 Investigators. Initial Q waves accompanying ST-segment elevation at presentation of acute myocardial infarction and 30-day mortality in patients given streptokinase therapy: an analysis from HERO-2. Lancet. 2006;367:2061.
Yamaji H, Iwasaki K, Kusachi S, et al. Prediction of acute left main coronary artery obstruction by 12 lead electrocardiography. ST segment elevation in lead VR with les s ST segment elevation in lead VI. J Am Coll Cardiol. 2001;48:1348.
Zehender, M, Utzolino, S, Furtwangler, A., et al. Time course and interrelation of reperfusion-induced ST changes and ventricular arrhythmias in acute myocardial infarction. Am J Cardiol. 1991;68:1138.
Zhong-qun Z, Wei W, Jun-feng W. Does left anterior descending coronary artery acute occlusion proximal to the first septal perforator counteract ST elevation in leads V5 and V6? J Electrocardiol. 2009;42:52.

 
Apartado anterior Siguiente apartado