Die ESC-STEMI Leitlinien sprechen explizit eine wichtige Konstellation an: klinisch Zeichen einer anhaltenden Ischämie, im EKG aber keine signifikante Hebungen. Hier gilt, was jeder Arzt wissen be”herz”igen sollte: Nicht Troponin-Labor, nicht EKG – die Anamnese und Untersuchung des Patienten sind die wichtigsten Faktoren in der Diagnostik.
In addition, there is a concern that some patients with acute occlusion of a coronary artery and ongoing MI, such as those with an occluded circumflex coronary artery, acute occlusion of a vein graft, or left main disease, may present without ST-segment elevation and be denied reperfusion therapy, resulting in a larger infarction and worse outcomes. Extending the standard 12-lead ECG with V7–V9 leads may identify some of these patients. In any case, suspicion of ongoing myocardial ischaemia is an indication for a primary PCI strategy even in patients without diagnostic ST-segment Elevation.
2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation: The Task Force for the management of acute myocardial infarction in patients presenting with ST-segment elevation of the European Society of Cardiology (ESC)