title: Comparative accuracy of electrocardiographic and vectorcardiographic criteria for inferior myocardial infarction.
abstract: Numerous criteria for the diagnosis of inferior wall myocardial infarction by electrocardiogram (ECG) and vectorcardiogram (VCG) have been published, but they have not been subjected to a systematic, independent evaluation. Accordingly, we studied 146 patients undergoing cardiac catheterization; 63 were normal and 83 had a history of infarction, a significant right coronary lesion and an inferior wall motion abnormality (inferior infarction group). No ECG or VCG criteria were considered in the designation of the two groups; rather, three sets of ECG and VCG criteria were evaluated for this purpose. Specificity was excellent (98-100%) and sensitivity was poor (4-34%) by all three sets of ECG criteria, but the 1949 ECG criteria of Meyers et al. are the least sensitive (4%, p less than 0.001). Specificity (90-100%) and sensitivity (82-84%) were very good by all three VCG criteria. The VCG criteria of Starr et al. gave no false-positive results in our normal group. Because of enhanced sensitivity, the overall accuracy of the VCG was higher than that of the ECG for the diagnosis of inferior infarction (90% vs 62%, p less than 0.001). We conclude that more recent ECG criteria for the diagnosis of inferior wall myocardial infarction are highly specific, but insensitive compared with VCG criteria.
mesh_terms: D004562:Electrocardiography; D005189:False Positive Reactions; D006801:Humans; D009203:Myocardial Infarction / Q000175:diagnosis*; D014672:Vectorcardiography