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February 24, 1999


Author Affiliations

Margaret A.WinkerMD, Deputy EditorIndividualAuthorPhil B.FontanarosaMD, Interim CoeditorIndividualAuthor

JAMA. 1999;281(8):705. doi:10-1001/pubs.JAMA-ISSN-0098-7484-281-8-jbk0224

In Reply: We thank Dr Kao for his thoughtful comments and agree that the ECG, and specifically the presence of new ST-segment elevation and new Q waves, plays an important role in aiding the diagnosis of MI. In particular in our review we found that the presence of a new ST-segment elevation was associated with likelihood ratios of 5.7 to 53.9, while the presence of any ST-segment elevation (which by definition includes ST-segment elevation that may have been present on a prior ECG) was associated with a likelihood ratio of only 11.2. Similarly, new Q waves, as opposed to any Q waves, also were associated with higher likelihood ratios and therefore more likely to occur in patients with, as opposed to those without, MI.