Table 4
Author, date and countryPatient groupStudy type (level of evidence)OutcomesKey resultsStudy weaknesses
McGuinness JB et al, 1976, Scotland898 patients admitted to CCU.Prospective diagnostic cohortSensitivity of initial51%
400 with AMI.ECG
Starck M and Vacek JL, 1987, USA221 ED chest pain patients. 39 with AMI.Prospective diagnostic cohortSensitivity of initial62%Air Force hospital, possible selection bias.
ECGNo raw cardiac enzyme data confirming how AMI diagnosed.
Sharkey SW et al, 1988, USA34 patients admitted to CCU. 34 with AMI.Prospective diagnostic cohortSensitivity of initial61%CCU population not ED.
ECGSmall population size.
Fesmire F et al, 1989, USA440 ED chest pain patients. 100 with AMI.Prospective diagnostic cohortSensitivity of initial47%No evidence of timing of the initial ECG.
ECG
Rouan G et al, 1989, USA918 ED chest pain patients. 811 with AMI.Prospective diagnostic cohortSensitivity of initial13%Interrator agreement of ECG interpretation not measured from separate participating ED.
ECG
Inclusion of AMI and ischaemic ECG changes.
Gibler B et al, 1992, USA616 ED chest pain patients. 108 with AMI.Prospective diagnostic cohortSensitivity of initial36%Recruitment criteria unclear.
ECGUnclear if series or selection of patients recruited
Young P and Green T, 1993, USA222 ED chest pain patients. 43 with AMI.Retrospective surveySensitivity of initial28%Retrospective study.
ECGStudy population mostly elderly
Zalenski R et al, 1993, USA149 ED chest pain patients. 34 with AMI.Prospective diagnostic cohortSensitivity of initial47.1%Small population
ECG
Fesmire F, 1998, USA1000 ED chest pain patients. 204 with AMI.Prospective diagnostic cohortSensitivity of initial55.4%? 34 patients had AMI following admission to ED.
ECG
Kudenchuk PJ et al, 1998, USA3027 ED chest pain patients. 1149 with AMI.Prospective diagnostic cohortSensitivity of initial69%Initial ECG taken by paramedics, not in ED.
ECG