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❤️ 4-Variable Subtle Anterior STEMI (Smith)

UseWhen to use: mild anterior ST elevation without obvious STEMI criteria.

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Strata≥23.4 favors subtle anterior LAD occlusion vs benign early repol. Positive score or ongoing pain/reciprocal c…

LimitsWhen not to use: obvious STEMI/LBBB/paced ECG. · Red flags: ongoing ischemia, reciprocal change, instability — do not … · Cannot: activate cath lab from formula alone or replace cardiology co…

SourceSmith 4-variable subtle anterior STEMI vs early-repolarization formula

Runs locally in your browser (no PHI uploaded). For licensed clinicians — not a substitute for clinical judgement.
Stored on this device for revisit reminders

This-shift next steps

After scoring: open the scene pack, peer scores, and the matching pathway. Local reference — no HIS write.

Who it is for
Adults with emergency chest pain when deciding observation, rule-out, or ACS.
Who it is not for
Chest pain already clearly non-cardiac. No new ECG score.
Formula and variables
HEART is history, ECG, age, risk factors, and troponin. GRACE is age, heart rate, systolic pressure, creatinine, Killip, arrest, ST shift, and marker; the variant stays as on this page. TIMI and TIMI STEMI both exist; this page does not pick a new variant. Killip is pump class. No new chest-pain score.
Result → next step
Low risk stays with this page’s rule-out or observation. Once ACS is established, the next page is reperfusion and antithrombotic care. Bleeding uses CRUSADE. Stent duration uses the DAPT page. No loading dose is written.No numeric dose until age, weight, renal function, and pregnancy are all known. Pregnancy is contraindication or caution only.ACS reperfusion / antithrombotic →
Guideline
2023 ESC ACS
Scene next step
📋ED chest pain / ACSOpen scene pack →
Related scores
Matching pathway
🧭stemiOpen pathway →
Score + version; reference only — not a substitute for care · no HIS write

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Methodology · worked example, guidelines & full notes
Clinical takeaway

Cut-point 23.4.

When to use

When to use: mild anterior ST elevation without obvious STEMI criteria.

How it works

1.196·STE60_V3 + 0.059·QTc − 0.326·R_V4; ≥23.4 favors occlusion.

Key points

  • Cut-point 23.4.
  • Three ECG inputs.
  • Next: serial ECG / troponin / consult.

References

  • Smith 4-variable subtle anterior STEMI vs early-repolarization formula

Worked calculation

The values below come from this tool's own example placeholders and are computed server-side with the formula shown on this page, so the arithmetic can be checked quickly. It demonstrates how to substitute values only — it is not clinical advice and not a real case.

STE at 60 ms after J in V32.0 mm
QTc (Bazett)420 ms
R-wave amplitude in V415 mm

→4-var score22.3

  • Cut-point：23.4
  • Cue：<23.4 — favors early repolarization (teaching cut-point)
Verification & sources · governance
FAQ

Frequently asked questions

Does 4-Variable Subtle Anterior STEMI (Smith) upload patient data? Where is it calculated?
Calculation runs locally in the browser; inputs and results are not uploaded. For licensed clinicians only; interpret with history, investigations and local protocols — not a diagnosis or prescription.
How is 4-Variable Subtle Anterior STEMI (Smith) calculated in practice? Can you show a worked example?
Inputs: STE at 60 ms after J in V3 2.0 mm, QTc (Bazett) 420 ms, R-wave amplitude in V4 15 mm → Result: 4-var score 22.3（Cut-point: 23.4, Cue: <23.4 — favors early repolarization (teaching cut-point)）
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