Although electrocardiography is frequently used as an initial test to detect or rule
out previous myocardial infarction (MI), the diagnostic performance of commonly used
electrocardiographic scoring systems is not well described. We aimed to determine
the diagnostic accuracy of (1) the Universal Definition, (2) Minnesota ECG Code (MC),
(3) Selvester QRS Score, and (4) assessment by cardiologists using late gadolinium
enhancement cardiovascular magnetic resonance imaging as the reference standard. Additionally,
the effect of electrocardiographic patterns and infarct characteristics on detecting
previous MI was evaluated. The 3-month follow-up electrocardiograms of 78 patients
with first-time reperfused ST elevation MI were pooled with electrocardiograms of
36 healthy controls. All 114 electrocardiograms were randomly analyzed, blinded to
clinical and LGE-CMR data. The sensitivity of the Universal Definition, MC, Selvester
QRS Score, and cardiologists to detect previous MI was 33%, 79%, 90%, and 67%, respectively;
specificity 97%, 72%, 31%, and 89%, respectively; diagnostic accuracy 54%, 77%, 71%,
and 74%, respectively. Probability of detecting MI by cardiologists increased with
an increasing number (odds ratio [OR] 2.00, 95% confidence interval [CI] 1.30 to 3.09),
width (OR 1.02, 95% CI 1.01 to 1.03), and depth (OR 1.16, 95% CI 1.07 to 1.27) of
Q waves as well as increasing infarct size (OR 1.15, 95% CI 1.06 to 1.25) and transmurality
(OR 1.05, 95% CI 1.01 to 1.08; p <0.05 for all). The time-consuming MC and rapid visual
assessment by cardiologists achieved the best and similar diagnostic accuracies to
detect previous MI. The diagnostic performance of all 4 electrocardiographic scoring
systems was modest and related to the number, depth, and width of Q waves as well
as increasing infarct size and transmurality. In conclusion, the exclusion of a previous
MI based solely on electrocardiographic findings should be done with caution. Future
studies are needed to define which patients should be referred to additional diagnostic
testing.
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Article info
Publication history
Published online: July 08, 2013
Accepted:
May 20,
2013
Received in revised form:
May 20,
2013
Received:
April 9,
2013
Footnotes
See page 1074 for disclosure information.
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Copyright
© 2013 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
