Cardiac infarction injury score: an electrocardiographic coding scheme for ischemic heart disease.

A multivariate decision-theoretic electrocardiogram (ECG) classification scheme called Cardiac Infarction Injury Score (CIIS) was developed using ECGs of 387 patients with myocardial infarction (MI) and 320 subjects without infarction. The most accurate and stable classification was achieved by using a combination of eight binary (single threshold), three ternary (two thresholds), and four ECG features measured on a continuous scale. For practical visual coding of ECGs, the CIIS coding procedure uses a checklist containing 12 items measured from the conventional 12-lead ECG. The CIIS test results indicate that, in comparison with conventional ECG criteria for MI used in clinical trials, the diagnostic accuracy can be considerably improved by optimizing feature and threshold selection and by multivariate analysis. The CIIS detected MI with a sensitivity of 85% and a specificity of 95%. Using a higher severity level, a specificity of 99% was achieved, with a sensitivity of 71%. One of the primary uses of the CIIS is coding of significant worsening of the ECG with new coronary events from annually recorded ECGs in clinical trials and epidemiologic studies.