A modified Anderson-Wilkins electrocardiographic acuteness score for anterior or inferior myocardial infarction1

Hedén, Bo; Ripa, Rasmus; Persson, Eva; Song, Qianzi; Maynard, Charles; Leibrandt, Paul; Wall, Thomas; Christian, Timothy F; Hammill, Stephen C; Bell, Samuel S; Pahlm, Olle; Wagner, Galen S

doi:10.1016/S0002-8703(03)00404-6

« Previous Next »American Heart Journal
Volume 146, Issue 5 , Pages 797-803, November 2003

A modified Anderson-Wilkins electrocardiographic acuteness score for anterior or inferior myocardial infarction¹ ☆

Bo Hedén, MD, PhD
- Department of Clinical Physiology, Lund University, Lund, Sweden
Rasmus Ripa, MD
- Duke University Medical Center, Durham, NCUSA
Eva Persson, MD
- Department of Clinical Physiology, Lund University, Lund, Sweden
Qianzi Song, MSc
- Duke University Medical Center, Durham, NCUSA
Charles Maynard, PhD
- University of Washington, Department of Health Services, Seattle, Wash, USA
Paul Leibrandt, MD
- Duke University Medical Center, Durham, NCUSA
Thomas Wall, MD
- LeBauer Research group, Moses Cone Memorial Hospital, Greensboro, NC, USA
Timothy F Christian, MD
- Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic and Mayo Foundation, Rochester, Minn, USA
Stephen C Hammill, MD
- Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic and Mayo Foundation, Rochester, Minn, USA
Samuel S Bell, BEnvd
- Duke University Medical Center, Durham, NCUSA
Olle Pahlm, MD, PhD
- Department of Clinical Physiology, Lund University, Lund, Sweden
Galen S Wagner, MD
- Duke University Medical Center, Durham, NCUSA
- Reprint requests: Galen S. Wagner, MD, Duke University Medical Center, 2400 Pratt St, Rm 0306, Durham, NC 27705, USA.

Received 5 November 2002; accepted 23 April 2003.

Abstract

Background

Optimal treatment of acute myocardial infarction (AMI) depends on the duration of the ischemia. The Anderson Wilkins (AW) electrocardiographic acuteness score has been shown to complement the historical timing in estimating the time interval from acute thrombotic coronary occlusion in patients presenting with chest pain and evolving myocardial infarction. The purposes of this study were to (1) compare the distributions of the previously developed AW acuteness score in a training population with either anterior or inferior AMI and (2) propose modifications to the formula to achieve distributions similar to the observed distributions of historical times from onset of pain.

Methods

Two hundred three and 177 patients were included as training and testing population, respectively. All patients had an anterior or an inferior AMI and were without confounding factors on the electrocardiogram.

Results

The training population had similar distributions of historical times from onset of pain, but differences in distributions of AW acuteness scores, between patients with anterior and inferior AMI (P < .0001). Eighty percent of the inferior AMI group had the highest possible AW acuteness score. Modification of a Q-wave criterion from ≥30 to ≥20 ms resulted in similar distributions in patients with anterior and inferior AMI both in the training and an independent testing population.

Conclusions

These results suggest that a modified AW acuteness score using a lower Q-wave duration criterion provides similar AMI timing information in patients with anterior and inferior locations. Clinical use of the AW acuteness score will only be practical if the calculation is automated.