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Electrocardiographic Differentiation between Acute Pulmonary Embolism and Non-ST Elevation Acute Coronary Syndromes at the Bedside


  • Conflict of Interest: The authors of this manuscript do not report any conflict of interest in connection with submitted article.

Address for correspondence: Andrzej Łabyk, M.D., Department of Internal Medicine and Cardiology, Lindley‘a str. 4, 02-005 Warsaw, Poland. Fax: +48 22 502 13 63; E-mail:


Background: Clinical picture of acute pulmonary embolism (APE), with wide range of electrocardiographic (ECG) abnormalities can mimic acute coronary syndromes.

Objectives: Assessment of standard 12-lead ECG usefulness in differentiation at the bedside between APE and non-ST elevation acute coronary syndrome (NSTE-ACS).

Methods: Retrospective analysis of 143 patients: 98 consecutive patients (mean age 63.4 ± 19.4 year, 45 M) with APE and 45 consecutive patients (mean age 72.8 ± 10.8 year, 44 M) with NSTE-ACS. Standard ECGs recorded on admission were compared in separated groups.

Results: Right bundle branch block (RBBB) and S1S2S3 or S1Q3T3 pattern were found in similar frequency in both groups (10 [11%] APE patients vs 6 [14%] NSTE-ACS patients, 27 [28%] patients vs 7 [16%] patients, respectively, NS). Negative T waves in leads V1-3 together with negative T waves in inferior wall leads II, III, aVF (OR 1.3 [1.14–1.68]) significantly indicated APE with a positive predictive value of 85% and specificity of 87%. However, counterclockwise axis rotation (OR 4.57 [2.74–7.61]), ventricular premature beats (OR 2.60 [1.60–4.19]), ST depression in leads V1-3 (OR 2.25 [1.43–3.56]), and negative T waves in leads V5-6 (OR 2.08 [1.31–3.29]) significantly predicted NSTE-ACS.

Conclusions: RBBB, S1S2S3, or S1Q3T3 pattern described as characteristic for APE were not helpful in the differentiation between APE and NSTE-ACS in studied group. Coexistence of negative T waves in precordial leads V1-3 and inferior wall leads may suggest APE diagnosis.

Ann Noninvasive Electrocardiol 2010;15(2):145–150

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