Scarborough EKG Criteria
I cannot provide specific management guidance for "Scarborough EKG criteria" because this term does not appear in any of the provided evidence, current cardiology guidelines, or established medical literature.
What You May Be Referring To
If you are asking about high-risk ECG patterns in acute coronary syndromes, the management approach is well-established and depends on the specific ECG findings:
For Persistent ST-Segment Elevation (>20 minutes)
Immediate reperfusion therapy is mandatory, with primary PCI within 120 minutes being the gold standard treatment 1, 2.
- Primary PCI should be performed within 90 minutes of first medical contact if presenting to a PCI-capable facility 3
- If PCI cannot be achieved within 120 minutes, fibrinolytic therapy should be administered within 30 minutes ("door-to-needle" time), followed by transfer for PCI within 24 hours 2, 3
- This applies to STEMI patients as it reflects acute total coronary occlusion requiring immediate myocardial salvage 1
For Non-ST-Elevation ACS (Transient ST Changes, ST Depression, T-Wave Abnormalities)
Risk stratification determines the timing of invasive management 1.
Very High-Risk Features (Immediate Invasive Strategy <2 hours):
- Hemodynamic instability or cardiogenic shock
- Recurrent or ongoing chest pain refractory to medical treatment
- Life-threatening arrhythmias or cardiac arrest
- Mechanical complications of MI
- Acute heart failure with refractory angina or ST deviation
- Recurrent dynamic ST- or T-wave changes, particularly with intermittent ST elevation 1
High-Risk Features (Early Invasive Strategy <24 hours):
- Rise or fall in cardiac troponin compatible with MI
- Dynamic ST- or T-wave changes (symptomatic or silent)
- GRACE score >140 1
Intermediate-Risk Features (Invasive Strategy <72 hours):
- Diabetes mellitus
- Renal insufficiency (eGFR <60 mL/min/1.73 m²)
- LVEF <40% or congestive heart failure
- GRACE risk score >109 and <140 1
Initial Medical Management for All ACS Patients
Dual antiplatelet therapy should be initiated immediately 1, 4:
- Aspirin 162-325 mg (or 75-325 mg per local protocols) 3, 4
- P2Y12 inhibitor selection 1, 4:
- Ticagrelor (180 mg loading, 90 mg twice daily) is recommended for moderate-to-high-risk patients
- Prasugrel (60 mg loading, 10 mg daily) for patients proceeding to PCI with known anatomy
- Clopidogrel (300 mg loading, 75 mg daily) if ticagrelor/prasugrel contraindicated or oral anticoagulation needed 1, 4
Special ECG Patterns Requiring Immediate Recognition
De Winter's pattern (upsloping ST depression with tall T waves in precordial leads) represents critical proximal LAD stenosis and should be treated as a STEMI-equivalent with immediate PCI 5.
Marked ST depression on 12-lead ECG in the context of ongoing ischemia warrants immediate coronary angiography due to the amount of myocardium in jeopardy 1
Important Caveats
- The ECG should be obtained within 10 minutes of first medical contact and interpreted by an experienced physician 6, 3
- Serial ECGs are essential when initial ECG is non-diagnostic but clinical suspicion remains high 3, 7
- High-sensitivity troponin results must be available within 60 minutes of blood sampling for optimal diagnostic accuracy 6
- Tall QRS complexes or other confounding factors (LVH, LBBB) can mask ischemic changes, making serial ECGs and troponin measurements critical 6
If "Scarborough criteria" refers to a specific institutional protocol or regional guideline, please provide additional context so I can offer more targeted guidance.