The late presenting STEMI: How ECG scores can be used to estimate event time

•Case of a 76 year old man presenting days after symptom onset with STEMI•The Anderson–Wilkins Acuteness score suggested an intermediate acuity infarction.•Aldrich & QRS score estimated 47%–56% of at risk myocardium was ischemic but viable.•Angiography and MRI confirmed vessel occlusion and anterolateral infarction.•ECG scores can help estimate areas of infarction and areas at risk in STEMI.

IntroductionPatients presenting with ST elevation myocardial infarction (STEMI) derive significant benefit from timely percutaneous coronary intervention (PCI). Electrocardiogram (ECG) scoring systems can complement history to estimate the infarction age and inform clinical decision-making.CaseA 76 year old man presented with eight days of dyspnea on exertion and chest pain. Triage ECG showed ST elevation and Q waves in the anterior leads. The patient was taken for coronary angiography and found to have a 100% occlusion of the left anterior descending artery.DiscussionDetermining timing of acute coronary syndromes is challenging. ECG indices aid clinical history by quantifying infarction acuity.