The patient was discharged, and 13 days later presented with identical chest pain, which again resolved, and had the following ECG after resolution of pain:
Outcome: This time, the troponin was positive [which one would expect when there is not just resolution of STE, but also T-wave inversion (Wellens')]. The patient underwent coronary angiography, which showed severe subtotal LAD disease and 70% left main disease. He underwent coronary artery bypass surgery.
This case illustrates the importance of paying close attention to the ECG and its evolution. Using the formula may help.