{'fraction_non_alphanumeric': 0.017424242424242425, 'fraction_numerical': 0.006818181818181818, 'mean_word_length': 5.7030456852791875, 'pattern_counts': {'":': 0, '<': 0, '<?xml version=': 0, '>': 0, 'https://': 0, 'lorem ipsum': 0, 'www.': 0, 'xml': 0}, 'pii_count': 0, 'substrings_counts': 0, 'word_list_counts': {'cursed_substrings.json': 0, 'profanity_word_list.json': 0, 'sexual_word_list.json': 0, 'zh_pornsignals.json': 0}}
The paramount importance of 12‐lead electrocardiography in the management of patients with acute myocardial infarction

The introduction of reperfusion therapies for patients presenting with acute myocardial infarction has been one of the major breakthroughs in modern cardiology. Apart from history and clinical presentation, a pattern of ST-segment elevation in two or more contiguous leads of the 12-lead electrocardiogram is the key to early and rapid diagnosis and allows the identification of candidates for reperfusion therapy [1]. The electrocardiogram made after reperfusion therapy gives a first impression on the amount of permanent myocardial damage (Q-waves) and also passes an initial verdict on the effectiveness of the applied reperfusion modality to restore flow not only in the epicardial coronary artery, but also in particular flow into the affected myocardium. The presence or absence of ST-segment elevation resolution has been shown to be an excellent predictor of clinical outcome in patients treated with thrombolytic therapy as well as primary angioplasty [2,3]. Although primary angioplasty has emerged as the preferred reperfusion modality, thrombolytic therapy still plays an important role whenever a timely performed primary angioplasty is not an option. Based on the electrocardiogram after thrombolytic therapy, a rescue angioplasty should be considered in all patients with significant residual or persistent ST-deviation [1]. In this issue of Catheterization and Cardiovascular Interventions, Lorgis et al. describe a cohort of 168 consecutive patients with ST-elevation myocardial infarction and failed thrombolytic therapy, defined as less than 50% ST-elevation resolution. Following rescue angioplasty patients were divided into two groups based on presence or absence of ST-elevation resolution as measured on the single worst electrocardiographic lead before thrombolysis compared to after rescue angioplasty. The 15% of patients without ST-elevation resolution had a lower proportion of patients with TIMI 2/3 flow after angioplasty, an increased use of intra-aortic balloon counterpulsation and a higher mortality compared to patients with ST-elevation resolution after angioplasty [4]. These new findings convincingly show the prognostic importance and clinical value of sequential electrocardiograms in patients treated with rescue angioplasty after failed thrombolytic therapy. It is therefore clear that irrespective of the choice of reperfusion strategy, electrocardiography plays a pivotal role in the identification of high risk patients and is a crucial element in clinical decision making.