Appendix 3

Characteristics of acute myocardial infarction (AMI) included studies.

StudyDesignSample size% AMIMean age% malesSettingInclusionExclusionReference standard AMI
Säwe, 197119,aProspective consecutive137396267CCUCentral chest pain (>15 m, <48 hr) or pulmonary oedema or shock or syncope or status anginosusKnown valvular lesion, acute hypovolaemia or intoxication, syncope without ECG evidence of AMIQ-wave and/or ST elevation or GOT, GPT, LDH changes, necropsy
Säwe, 197220,aProspective consecutive921496560CCUCentral chest pain (>15 m, <48 hr) or pulmonary oedema or shock or syncope or status anginosusKnown valvular lesion, acute hypovolaemia or intoxication, syncope without ECG evidence of AMIQ-wave and/or ST elevation or GOT, GPT, LDH changes or autopsy findings myocardial necrosis
Van der Does, et al, 198021Prospective consecutive134375455GPRecent chest pain or dyspnoea, palpitations or dizziness or syncope upper abdominal pain or mood changes<25 yr women, <20 yr menWHO criteria for AMI, at least 4 pts score: ECG typical-2pt, suspect-1pt, ditto symptoms and enzymes
Short, 198122Prospective ?456406257CarOne or more attacks of spontaneous chest pain and who were referred for cardiology opinionIll enough for hospitalisation or diagnosis of coronary disease regarded as definiteHistory and ECG (Minnesota code) or twice limit AAT at 24–48 hr after onset
Lee, et al, 198523Prospective consecutive596175648EDChief complaint of anterior, precordial or left lateral chest painLocal trauma, abnormalities on chest X-ray, <25 yrOne of: characteristic evolution of enzyme levels (CK-MB or LDH or CK) or Q-waves of scintiscan
Tierney, et al, 198624Prospective ?49212??EDAnterior chest pain as one of their complaints<30 yr men, <40 yr femaleWhen cardiac enzyme CK elevated and CK-MB >4% or LDH1> (or equal) LDH or when no enzyme: new abnormal Q-wave
Herlihy, et al, 198726Prospective consecutive26544??CCUChest pain and electrographic changesIllness or medication that could produce nausea, with thrombolytic medicationCK and ECG
Solomon, et al, 198927Prospective consecutive773414?50EDChief complaint of anterior, precordial or left lateral chest painLocal trauma, abnormalities on chest X-ray, <30 yr, >4 visitOne of: characteristics evolution of enzyme levels (CK-MB or LDH or CK), Q-waves, scintiscan, sudden unexplained death within 72 hr
Berger, et al, 199028Prospective consecutive278365769CCUAdmitted to the hospital, complaining chiefly of chest painTrauma, transferred from other hospital with a diagnosisChest pain, ECG changes indicating myocardial infarction, significant CK elevation
Jonsbu, et al, 199129Prospective consecutive20037??CCUAdmitted to hospital with suspected acute heart diseaseUnable to give reliable medical historyClinical history, ECD signs, enzyme activity, ventriculography, scintigraphy, autopsy
Gaston-Johansson, et al, 199130Prospective consecutive9440?71CCUChest pain suggesting AMI>75 yr, cardiogenic shockTwo of: typical clinical symptoms and chest pain > 15 mins, AAT or CK elevations, Q waves ST elevation or T inversion
Hartford, et al, 199331Prospective consecutive22648??CCUBecause of suspected AMIVery poor clinical condition, does not understand SwedishTwo of three: chest pain > 15 min, aminotransferase, new Q-waves in two leads
Everts, et al, 199633Prospective consecutive902506471CCUChest pain with possible AMIHypotension, severe congestive heart failure, severe UA, cognitive limitation, languageTwo of three: chest pain >15 min, aminotranferase, new Q-waves in two leads
Pfister, et al, 199734Prospective consecutive327186465EDChest pain (>10 min), irradiation (epigastric, jaw, L extremity) during angina, dyspnoea, non-traumatic or toxic cardiac arrest<20 yr, traumaAt least two of: history, ECG, CK-MB
Lopez-Jiminez et al, 199835Prospective consecutive26946?45EDChief complaint of chest painLocal trauma, abnormalities on chest X-ray, <30 yr, >4 visit, prior AMI, A, PTCA, bypassOne of: characteristics evolution of enzyme levels (CK-MB or LDH or CK), Q-waves, scintiscan, sudden unexplained death within 72 hr
Pope, et al, 199836Prospective consecutive10 68985952EDChief complaint chest, left arm, jaw or epigastric pain or discomfort, dyspnoea, dizziness, palpitations or other symptoms suggestive of acute ischemia<30yr, 18yr if suspected to have used cocaineWHO criteria for AMI
Graff, et al, 200037Prospective consecutive10 6782??EDAll patients with possible AMI were a rapid ECG was performedNoICD-9-CM 410. 01/11/21/31/41/51/61/71/81/91
Herlitz, et al, 200239Retrospective consecutive930147151ParaChest pain or slightest suspicion of an acute coronary syndromeNoTwo of: chest pain >15 min, CK more than twice upper limit, Q-waves
Goodacre, et al, 200240Prospective consecutive89345362CPOUChest pain (patients at low risk)<25 yr, trauma, new ECG changes consistent with ischemia, comorbidity necessitating hospitalisation, definite unstable anginaWHO criteria for AMI
Baxt, et al, 200241Prospective 16/ day220465340EDAnterior chest pain prompting an ECG<24 yrEuropean Society of Cardiology criteria
Albarran, et al, 200242Prospective consecutive54148?68CCUAcute chest painPain >24 hr, <18 yr, no EnglishTroponin I >6 ng/ml and ECG changes
Svensson, et al, 200344Prospective consecutive538296958ParaChest pain or discomfort >15 min, within last 6 hr, dyspnoea, or any condition suggesting acute coronary syndromeLung diseaseTwo of: typical symptoms, Q-waves, CK-MB> 10 ng/ml or troponin >0.05 ng/ml

  • ↵a The patients of the first article are part of the second study. The signs and symptoms discussed in the two studies are different. Car = cardiologist; CCU = coronary care unit or admitted to hospital, CPOU = chest pain observation unit, ECD = electrocardiogram, ED = emergency department, Para = paramedics of an ambulance. A = angina. AAT = aspartate aminotransferase. AMI = acute myocardial infarction. CK = creatine kinase. CK-MB = CK isoenzyme. ECG = echocardiogram. GOT = aspartate aminotransferase. GPT = alanine transferase. ICD = International Classification of Diseases. LDH = lactate dehydrogenase. LDH1 = lactate dehydrogenase isoenzyme 1. UA = unstable angina. WHO = World Health Organization.