• Identifying ST-segment changes in patients with LVH is frequently associated with false-positive diagnoses of acute coronary syndrome
• This study analyzed the ACTIVATE-SF database, a registry of consecutive emergency department STEMI diagnoses from 2 medical centers (411 patients)
• In patients with anterior territory ST-elevation, using a ratio of ST segment to R-S–wave magnitude >25% as a diagnostic criteria for STEMI significantly improved specificity for an angiographic culprit lesion (true positive) 
• Although this rule requires further study in a larger population it may augment current criteria for determining which patients with ECG LVH should undergo PCI

References