Redefinition of the Q wave -- is there a clinical problem?
This study evaluated the potential consequences of the redefined joint European/American electrocardiographic criteria for an established myocardial infarction (MI). New and previous diagnostic Q-wave criteria were used in patients with stable angina pectoris. Seventy-nine patients with and 77 patients without a documented previous MI were compared using the results of myocardial perfusion imaging at rest as a reference. With the new Q-wave criteria, 71% of the former group and 40% of the latter had evidence of established MI compared with 33% and 3% when using the previous criteria (p <0.0001). Sensitivity, specificity, and positive and negative predictive values were 71%, 60%, 64%, and 67% for the new criteria versus 33%, 97%, 93%, and 59% with the previous criteria. These data suggest that that the new Q-wave criteria may be too nonspecific, resulting in an inappropriately high number of false-positive results.
Jensen
Jesper K
JK
Department of Cardiology, Odense University Hospital, Odense, Denmark. jesperkjensen@dadlnet.dk
Øvrehus
Kristian
K
Møldrup
Mette
M
Mickley
Hans
H
Høilund-Carlsen
Poul Flemming
PF
D000328:Adult; D000368:Aged; D016022:Case-Control Studies; D004562:Electrocardiography; D005188:False Negative Reactions; D005189:False Positive Reactions; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000503:physiopathology*; D017410:Practice Guidelines as Topic; D011877:Radionuclide Imaging; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity