Calculation used to distinguish early repolarization from subtle anterior MI.
Excluded EKG findings:
- Obvious anterior STEMI
- Bundle branch block
- LVH
- LV aneurism
- T wave inverted in V2-6 (not due to persistent juvenile T wave inversion)
- STE > 5mm in any lead
- Terminal QRS distortion (V2 and V3 lack both S and J waves)
- Leads V2-5 have a convex ST segment
- Significant ST depression in II, III, &/or AVF
- ST depression in V2-6
- Pathologic Q waves in V2, V3, or V4
Using score of 23.4 as cutoff: Sensitivity 86%, Specificity 91%, Positive LR 9.2, Negative LR 0.1.
Using score of 22 as cutoff: Sensitivity 96%, Specificity 81%.
This formula has not been prospectively or externally validated.
Formula = (1.196*STE) + (0.059*QTc) - (0.326*R wave)
Smith SW et al. Electrocardiographic Differentiation of Early Repolarization From Subtle Anterior ST-Segment Elevation Myocardial Infarction. Ann Emerg Med. 2012; 60(1): 45-56.