title: Reliability using the universal classification of acute myocardial infarction compared to ST-segment classification.
abstract: OBJECTIVE
  To study the inter-physician reliability using the universal classification (UC) of acute myocardial infarction (AMI) compared to the ST-segment classification (STC). The UC is based on clinical, electrocardiographic (ECG), and pathophysiologic characteristics compared to the STC, which is mainly ECG based.
  
  
  METHODS
  In this registry of consecutive patients with AMI presenting to a tertiary hospital, we studied the inter-physician reliability [weighted kappa (wK)] using the UC and the STC. Two physician investigators independently classified each patient with AMI according to the UC and STC, and a third senior physician investigator resolved any disagreement.
  
  
  RESULTS
  The study included Type 1=226 (89.7%), Type 2=16 (6.3%), Type 3=3 (1.2%), Type 4a=1 (0.4%), Type 4b=4 (1.6%), Type 5=2 (0.8%), ST-segment-elevation AMI (STEMI)=140 (55.6%), and non-ST-segment-elevation AMI (NSTEMI)=112 (44.4%). Inter-physician reliability using the UC was very good (wK=0.84, 95% CI 0.68-0.99) and using the STC was good (wK=0.78, 95% CI 0.70-0.86). Of patients with Type 1 AMI, 57.1% were STEMI and 42.9% were NSTEMI. In contrast, of patients with Type 2 AMI, 18.8% were STEMI and 81.2% were NSTEMI.
  
  
  CONCLUSIONS
  The UC is a reliable method to classify patients with AMI and performs better than the STC in this study. Validation of the two classifications should be performed in large prospective studies.
authors.affiliation: Washington Hospital Center, Georgetown University, Washington, DC 20010, USA. manuel.a.gonzalez@medstar.net
authors.forename: Manuel A
authors.initials: MA
authors.lastname: Gonzalez
authors.forename: Rana A
authors.initials: RA
authors.lastname: Marzouq
authors.forename: Summiyah
authors.initials: S
authors.lastname: Nasir
authors.forename: Surovi
authors.initials: S
authors.lastname: Hazarika
authors.forename: Michael B
authors.initials: MB
authors.lastname: Burris
authors.forename: Courtney
authors.initials: C
authors.lastname: Saunders
authors.forename: Christopher P
authors.initials: CP
authors.lastname: Porterfield
authors.forename: Dana J
authors.initials: DJ
authors.lastname: Eilen
authors.forename: Karyll De J
authors.initials: Kde J
authors.lastname: Gonzalez
authors.forename: Amit A
authors.initials: AA
authors.lastname: Patel
authors.forename: Mayelin
authors.initials: M
authors.lastname: Prieto-Gonzalez
authors.forename: Toney
authors.initials: T
authors.lastname: Graham
authors.forename: Saed
authors.initials: S
authors.lastname: Awadallah
authors.forename: John D
authors.initials: JD
authors.lastname: Rose
authors.forename: Wayne E
authors.initials: WE
authors.lastname: Cascio
mesh_terms: D000208:Acute Disease; D000368:Aged; D004562:Electrocardiography / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000145:classification* / Q000175:diagnosis; D011237:Predictive Value of Tests; D012042:Registries; D015203:Reproducibility of Results; D012189:Retrospective Studies