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J Electrocardiol. 2011 Jan-Feb;44(1):69-73. doi: 10.1016/j.jelectrocard.2010.10.037.

The new universal definition of myocardial infarction criteria improve electrocardiographic diagnosis of acute coronary syndrome.

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Department of Medicine, University of California-San Francisco, 505 Parnassus Ave., San Francisco, CA 94143-0124, USA.



To assess whether revised electrocardiographic (ECG) criteria improve emergency department identification of patients with acute myocardial infarction (MI) or unstable angina (UA) and predict outcome, we studied 120 patients with a nondiagnostic initial ECG by prior criteria. Electrocardiograms were read in a blinded fashion months apart with standard and then revised criteria, and analyzed by χ(2) and logistic regression analysis.


In 12 subjects (10%), the initial ECG was now interpreted as diagnostic of ischemia. Eleven (92%) had an MI, 1 had UA (8%), and none had a noncardiac diagnosis. Ischemic ECG changes were strongly associated with MI or UA (P = .003). At 1-year follow-up, ECG changes diagnostic of ischemia were associated with a trend toward higher mortality (25% vs 7%, P = .07), but after adjustment for clinical factors, ECG changes were not an independent predictor of 1-year mortality.


Revision of the ECG criteria for ischemia was associated with enhanced diagnostic performance and identified a subset of patients at higher risk.

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