title: Comparison of different electrocardiographic scoring systems for detection of any previous myocardial infarction as assessed with cardiovascular magnetic resonance imaging.
abstract: 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.
authors.affiliation: Department of Cardiology, Maastricht University Medical Center, Maastricht, The Netherlands; Department of Radiology, Maastricht University Medical Center, Maastricht, The Netherlands; Cardiovascular Research Institute Maastricht, Maastricht University Medical Center, Maastricht, The Netherlands.
authors.forename: Caroline
authors.initials: C
authors.lastname: Jaarsma
authors.forename: Sebastiaan C
authors.initials: SC
authors.lastname: Bekkers
authors.forename: Zaki
authors.initials: Z
authors.lastname: Haidari
authors.forename: Martijn W
authors.initials: MW
authors.lastname: Smulders
authors.forename: Patricia J
authors.initials: PJ
authors.lastname: Nelemans
authors.forename: Anton P
authors.initials: AP
authors.lastname: Gorgels
authors.forename: Harry J
authors.initials: HJ
authors.lastname: Crijns
authors.forename: Joachim E
authors.initials: JE
authors.lastname: Wildberger
authors.forename: Simon
authors.initials: S
authors.lastname: Schalla
mesh_terms: D000328:Adult; D003937:Diagnosis, Differential; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D019028:Magnetic Resonance Imaging, Cine / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis* / Q000503:physiopathology; D009206:Myocardium / Q000473:pathology*; D011446:Prospective Studies; D012372:ROC Curve; D015203:Reproducibility of Results; D012720:Severity of Illness Index