Use of the initial electrocardiogram to predict in-hospital complications of acute myocardial infarction

N Engl J Med. 1985 May 2;312(18):1137-41. doi: 10.1056/NEJM198505023121801.


We evaluated the initial electrocardiogram as a predictor of complications in 469 patients with suspected acute myocardial infarction. An electrocardiogram was classified as positive if it showed one or more of the following: evidence of infarction, ischemia, or strain; left ventricular hypertrophy; left bundle-branch block; or paced rhythm. Forty-two (14 per cent) of 302 patients with positive electrocardiograms had at least one life-threatening complication (ventricular fibrillation, sustained ventricular tachycardia, or heart block), as compared with 1 (0.6 per cent) of 167 patients with a negative electrocardiogram. Life-threatening complications were therefore 23 times more likely if the initial electrocardiogram was positive (P less than 0.001). Other complications were 3 to 10 times more likely (P less than 0.01), interventions were 4 to 10 times more likely (P less than 0.05), and death was 17 times more likely (P less than 0.001) in patients with a positive electrocardiogram. We conclude that patients with a negative initial electrocardiogram have a low likelihood of complications and could be admitted to an intermediate care unit instead of a coronary care unit. This would reduce admissions to the coronary care unit by 36 per cent and thereby save considerable hospital costs without compromising patient care.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Connecticut
  • Coronary Care Units / statistics & numerical data
  • Cost-Benefit Analysis
  • Diagnostic Tests, Routine*
  • Electrocardiography*
  • Emergency Service, Hospital*
  • Heart Block / diagnosis
  • Hospital Bed Capacity, 500 and over
  • Humans
  • Myocardial Infarction / complications*
  • Myocardial Infarction / diagnosis
  • Myocardial Infarction / physiopathology
  • Prognosis
  • Tachycardia / diagnosis
  • Ventricular Fibrillation / diagnosis
  • Vermont