The accuracy of diagnosis of myocardial infarction; a clinicopathologic study.

Abstract 1.1. Two hundred and sixty-six postmortem records of a consecutive series of patients found to have died from myocardial infarction, or suspected of dying from this cause in the Royal Infirmary, Edinburgh, during the years 1954 and 1955 have been reviewed. 2.2. In this hospital the accuracy rate in the diagnosis of myocardial infarction is surprisingly low, only 44 per cent when the examples revealed at autopsy and unsuspected clinically are taken into account. The major diagnostic errors occurred in patients who died suddenly or presented in an atypical way. 3.3. A greater awareness of the possibility of underlying myocardial infarction in elderly patients with unexplained heart failure or pleural effusions, in patients with cerebrovascular accidents, and in postoperative patients whose condition inexplicably deteriorates might lead to a decrease in diagnostic errors. 4.4. About 50 per cent of sudden deaths are due to myocardial infarction; anyone who dies suddenly, having given previous evidence, either clinical or electrocardiographic, of coronary artery disease is almost certain to have died in this way. 5.5. The electrocardiographic diagnosis of recent myocardial infarction is very accurate, and a clinical diagnosis alone without electrocardiographic corroboration, when this is available, is no longer justifiable.