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The initial triage of a patient with suspected acute myocardial infarction is strongly dependent on the patient's history. This fact is clearly demonstrated by the observation that the initial ECG is normal or nonspecific in 6 to 20 percent of patients with acute MI. To determine whether an initially normal ECG has diagnostic or prognostic significance, these investigators reviewed data from a large prospective study of 7115 patients with chest pain.
They identified 1024 patients with acute MI; 107 of these patients had normal or nonspecific initial ECGs and 811 had initial ECGs highly suggestive of MI. Those with ECGs suggestive of MI were significantly more likely than the other group to have had prior coronary artery disease, but were as …