van der Ende et al identified factors for a myocardial infarction going unrecognized on an electrocardiogram. A patient with an unrecognized myocardial infarction is at increased risk for death. The authors are from the University of Groningen in The Netherlands.

Patient selection: myocardial infarction


Outcome: failure to recognize on an electrocardiogram (ECG)


Predictors for an acute myocardial infarction going unrecognized on an ECG:

(1) age < 50 years

(2) female gender

(3) no or minor cardiovascular risk factors (absence of classical risk factors)

(4) diabetes mellitus (Table 2)


Other factors not included in the report:

(1) clinician with limited skill in reading an ECG

(2) subtle ECG changes

(3) failure to measure the serum troponin

(4) single ECG (no follow-up)

(5) unknown substance abuse (methamphetamine, cocaine)

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