Non-ST-Segment Elevation Myocardial Infarction: A Novel and Robust Approach for Early Detection of Patients at Risk

N on-ST-elevation myocardial infarction (NSTEMI) is lower on the severity spectrum of acute coronary syndromes than is myocardial infarction (MI), resulting from complete occlusion of a major coronary artery. As the name implies, it is a syndrome that does not exhibit the dramatic ST elevation observed in the standard 12-lead ECG in chest pain patients with confirmed acute MI. The important clinical significance of NSTEMI is that delay in diagnosis can lead to increased morbidity, risk of arrhythmia, and death. The article Clinical Utility of Ventricular Repolarization Dispersion for Real-Time Detection of Non-ST Elevation Myocardial Infarction in Emergency Departments in this issue of the Journal by Al-Zaiti et al is a timely presentation of a new approach to quickly diagnose NSTEMI and significantly reduce the time to treatment in these patients. The marker, ventricular repolarization dispersion (VRD), incorporates much more information in the ECG than that provided by measuring elevation of the ST segment and, thus, heralds the emergence of more powerful and robust methods of assessing ECG morphology and dynamics than can be provided by classical interval and amplitude measurements.