The full content of Annals is available to subscribers

Subscribe/Learn More  >
Original Research |

Limitations of the Electrocardiogram in Estimating Infarction Size after Acute Reperfusion Therapy for Myocardial Infarction

Timothy F. Christian, MD; Ian P. Clements, MD; Thomas Behrenbeck, MD, PhD; Kenneth C. Huber, MD; James H. Chesebro, MD; Bernard J. Gersh, MD, ChB, DPhil; and Raymond J. Gibbons, MD
[+] Article, Author, and Disclosure Information

Grant Support: In part by a grant from E. I. du Pont de Nemours and Company.

Requests for Reprints: Raymond J. Gibbons, MD, Mayo Clinic, Rochester, MN 55905.

Current Author Addresses: Drs. Christian, Clements, Behrenbeck, Huber, Chesebro, Gersh, and Gibbons: Mayo Clinic, Rochester, MN 55905.

© 1991 American College of PhysiciansAmerican College of Physicians

Ann Intern Med. 1991;114(4):264-270. doi:10.7326/0003-4819-114-4-264
Text Size: A A A

Objective: To assess the ability of the 12-lead electrocardiogram to estimate infarction size after reperfusion therapy for acute myocardial infarction.

Design: The presence or absence of Q waves and the Selvester QRS score obtained before and after hospital discharge were compared with radionuclide estimates of infarction size and ejection fraction at discharge and 6 weeks later, regional wall motion at discharge and 6 weeks later, and myocardial perfusion defect size quantitated with Tc-99m-sestamibi at discharge.

Setting: A tertiary referral center.

Patients: A consecutive series of 43 patients with acute myocardial infarction who received acute reperfusion therapy and were assessed using 12-lead electrocardiography, radionuclide angiography,and Tc-99m-sestamibi tomographic imaging before discharge.

Interventions: All 43 patients received acute reperfusion therapy: 21 patients received intravenous tissue plasminogen activator, and 22 patients underwent primary percutaneous transluminal coronary angioplasty.

Main Outcome Measure: The correlation of QRS score and Q waves with three radionuclide estimates of infarction size.

Results: A significant correlation was found between myocardial perfusion defect size at discharge and both left ventricular ejection fraction and regional wall motion at discharge and 6 weeks later (r = -0.71 to -0.81; all comparisons, P < 0.001). Little correlation was found between electrocardiographic findings and radionuclide measurements of left ventricular function and perfusion. Presence or absence of Q waves at discharge was not associated with any difference in ejection fraction, regional wall motion, or perfusion defect at discharge. No correlation was found between QRS score and ejection fraction or myocardial perfusion defect size at discharge. The QRS score at discharge correlated only weakly with regional wall motion at discharge and 6 weeks later. This lack of correlation was unchanged when electrocardiograms obtained after hospital discharge were analyzed.

Conclusion: Although inexpensive and readily available, the 12-lead electrocardiogram does not appear to provide a reliable estimate of infarction size after reperfusion therapy for acute myocardial infarction.





Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).


Submit a Comment/Letter
Submit a Comment/Letter

Summary for Patients

Clinical Slide Sets

Terms of Use

The In the Clinic® slide sets are owned and copyrighted by the American College of Physicians (ACP). All text, graphics, trademarks, and other intellectual property incorporated into the slide sets remain the sole and exclusive property of the ACP. The slide sets may be used only by the person who downloads or purchases them and only for the purpose of presenting them during not-for-profit educational activities. Users may incorporate the entire slide set or selected individual slides into their own teaching presentations but may not alter the content of the slides in any way or remove the ACP copyright notice. Users may make print copies for use as hand-outs for the audience the user is personally addressing but may not otherwise reproduce or distribute the slides by any means or media, including but not limited to sending them as e-mail attachments, posting them on Internet or Intranet sites, publishing them in meeting proceedings, or making them available for sale or distribution in any unauthorized form, without the express written permission of the ACP. Unauthorized use of the In the Clinic slide sets will constitute copyright infringement.


Buy Now for $42.00

to gain full access to the content and tools.

Want to Subscribe?

Learn more about subscription options

Related Articles
Topic Collections
PubMed Articles
Sex differences in young patients with acute myocardial infarction: A VIRGO study analysis. Eur Heart J Acute Cardiovasc Care Published online Aug 2, 2016;
Prolonged-QT and myocardium recovery after primary PCI: a cMRI study. Eur J Clin Invest Published online Aug 27, 2016;
Forgot your password?
Enter your username and email address. We'll send you a reminder to the email address on record.