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Morris N, Reynard C, Body R. The low accuracy of the non-ST-elevation myocardial infarction electrocardiograph criteria of the fourth universal definition of myocardial infarction. HONG KONG J EMERG ME 2019. [DOI: 10.1177/1024907919866364] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Background: The electrocardiograph has been integral to the diagnosis of acute coronary syndromes since the mid-20th Century and is an important initial investigation that chest pain patients undergo on presentation to the Emergency Department. The Fourth Universal Definition of Myocardial Infarction recommends using dichotomous cut-offs to identify ischaemic electrocardiographs. Objectives: We aimed to summarise the existing knowledge to inform emergency clinicians about the diagnostic accuracy of the new guidelines. Methods: We performed a systematic review and a narrative analysis due to the heterogeneity of the studies. Results: We were able to obtain diagnostic characteristics for 10 papers. The ST-depression criteria were highly specific but poorly sensitive in five papers, with a specificity of 97.2%–99.3% and a sensitivity of 16.6%–20.0%. The remaining papers reported a higher sensitivity of 25.7%–58.6% but a lower specificity of 86.0%–91.2%. T wave inversion demonstrated poor specificity; the papers that looked at 0.1 mV T wave inversion demonstrated a sensitivity of 26.9%–46.8% and a specificity of 68.6%–86.4%. Conclusion: The heterogeneous evidence database demonstrates that the Fourth universal definition’s diagnostic performance varies wildly. Apart from two outlying papers, ST-depression has suboptimal sensitivity but high specificity. T wave inversion appears to be more sensitive yet less specific.
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Affiliation(s)
- Niall Morris
- Division of Cardiovascular Sciences, The University of Manchester, Manchester, UK
- Emergency Department, Manchester Royal Infirmary, Manchester, UK
- Manchester University Foundation Hospital NHS Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - Charles Reynard
- Division of Cardiovascular Sciences, The University of Manchester, Manchester, UK
- Manchester University Foundation Hospital NHS Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - Richard Body
- Division of Cardiovascular Sciences, The University of Manchester, Manchester, UK
- Manchester University Foundation Hospital NHS Trust, Manchester Academic Health Science Centre, Manchester, UK
- Manchester Metropolitan University, Manchester, UK
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