Evaluating enhancing the acute myocardial infarction criteria in the Glasgow electrocardiogram analysis program by including ST depression

The aims of this study were to investigate if the acute myocardial infarction (MI) criteria in the University of Glasgow ECG analysis program (Uni-G) could be enhanced by including new lead pairings and to explore alternative criteria based on STEMI equivalence. 912 12-lead ECGs were recorded in ambulances on patients with a suspected acute coronary syndrome. The ACC/ESC and the Uni-G criteria were modified to include pairings {III,-aVL}, {-III,aVL}, and {-V2,-V3}. Using the hospital discharge diagnosis as the gold standard, the modified criteria were evaluated. Significant changes in sensitivity (SE) and specificity (SP) were evident using the modified ACC/ESC criteria: SE from 72.1% to 75.4% (p=0.002); SP from 88.1% to 86.6% (p=0.004). The current Uni-G criteria gave better results than the modified ACC/ESC criteria (SE 77.6% and SP 93.9%.). All attempts at extending the Uni-G criteria resulted in a decrease in SP.