The American College of Physicians, American College of Emergency Physicians, and Society for Cardiovascular Angi- ography and Interventions assigned official representatives. 1.3. Document Review and Approval This document was reviewed by 2 outside reviewers each nominated by the ACCF and the AHA, as well as 2 review- ers each from the American College of Emergency Physicians and Society for Cardiovascular Angiography and Interven- tions and 22 individual content reviewers (including members from the ACCF Interventional Scientific Council and ACCF Surgeons Scientific Council). All reviewer RWI information was distributed to the writing committee and is published in this document (Appendix 2). This document was approved for publication by the gov- erning bodies of the ACCF and the AHA and was endorsed by the American College of Emergency Physicians and Society for Cardiovascular Angiography and Interventions. 2.1. Definition and Diagnosis STEMI is a clinical syndrome defined by characteristic symp- toms of myocardial ischemia in association with persistent electrocardiographic (ECG) ST elevation and subsequent release of biomarkers of myocardial necrosis. Diagnostic ST elevation in the absence of left ventricular (LV) hypertrophy or left bundle-branch block (LBBB) is defined by the Euro- pean Society of Cardiology/ACCF/AHA/World Heart Fed- eration Task Force for the Universal Definition of Myocardial Infarction as new ST elevation at the J point in at least 2 con- tiguous leads of 2 mm (0.2 mV) in men or 1.5 mm (0.15 mV) in women in leads V2 V3 and/or of 1 mm (0.1 mV) in other contiguous chest leads or the limb leads.7 The major- ity of patients will evolve ECG evidence of Q-wave infarc- tion. New or presumably new LBBB has been considered a STEMI equivalent. 