stemi criteria

STEMI on ECG• New ST elevation at J-point in 2 contiguous leads with cut-

points:

• ≥ 0.2 mV in men ≥ 40 years in leads V2 - V3

• ≥ 0.25 mV in men < 40 years in leads V2 - V3

• ≥ 0.15 in women in leads V2 - V3

• ≥ 0.1 mV in all other leads

• In the absence of LVH and LBBB

examples of ST-elevation in MI

Criteria

Paul Sia

for diagnosing

STEMIon ECG

3rd Universal Definition of MI (2012)

STEMI on ECG• New ST elevation at J-point in 2 contiguous leads with cut-

points:

• ≥ 0.2 mV in men ≥ 40 years in leads V2 - V3

• ≥ 0.25 mV in men < 40 years in leads V2 - V3

• ≥ 0.15 in women in leads V2 - V3

• ≥ 0.1 mV in all other leads

• In the absence of LVH and LBBB

examples of ST-elevation in MI

General pitfalls• Beware of baseline ECG abnormalities that may obscure

interpretation

• LBBB

• refer to Sgarbossa’s criteria

• LVH

• J-point elevation syndromes eg, Brugada

• PE

• Peri/myocarditis

• Cardiomyopathy, including Takotsubo

• Cocaine use

• Cardiac pacing

STEMI location• septal

• V1, V2

• inferior

• II, III, aVF

• reciprocal changes: I, aVL

• lateral

• I, aVL, V5, V6

• reciprocal changes: II, III, aVF

• anterior

• V3, V4

• anteroseptal

• V1, V2, V3, V4

• anterolateral

• I, aVL, V3, V4, V5, V6

• reciprocal changes: II, III, aVF

• posterior

• V7, V8, V9

• reciprocal changes: V1, V2, V3, V4

Anterolateral STEMI

ECG 1

Inferior STEMI

ECG 2

ECG 3

Inferolateral STEMI+ Horizontal ST depression V1-3

+ Tall R waves, upright T-waves V2-3

ECG 3 + posterior leads

Inferior-lateral-posterior STEMI

References• Bax, Jeroen J., et al. "Third Universal

Definition of Myocardial Infarction." Journal of the American College of Cardiology 60.16 (2012): 1581-1598.