So-called “intermediate coronary syndrome”(IMCS) was studied from various standpoints, as described below.
1) Cases were classified into 4 groups:(a) acute myocardial infarction (MI) 155 cases, (b) IMCS 26 cases, in which infarction-like anginal pain continued more than 15 minutes, but ECG criteria were not satisfied, (c) angina pectoris at rest, 17 cases, in which attacks continued more than 30 minutes, but chest pain was not so severe, and (d) ordinary angina pectoris, 107 cases, which includes angina of effort and angina at rest with chest pain of shorter duration.
The incidence of minor ECG changes of MI, such as deep Q alone or inverted coronary T alone, in IMCS was statistically higher than those in ordinary angina. Cases with later developed MI showed Q wave in the previous ECG more frequently than those without development of MI. Incidence of minor ECG changes in resting angina was lower than IMCS but significantly higher than ordinary angina.
2) In order to examine the differences in ECG interpretation among electrocardiographers, 18 heart specialists were asked to interprete 50 ECG showing possible MI. Of 50 ECGs, 14 ECG were interpreted as MI by 18 cardiologists, and 7 by 17 cardiologists.
The cases, which were diagnosed as MI by more than 15 of 18 cardiologists, were diagnosed as MI also by electronic computer using our interpretation logics. In the cases, in which cardiologist's evaluation was diverse, exhibited the minor ECG findings of MI.
3) Of 67 cases autopsied during the period of this investigation, including various kinds of diseases, 27 had infarcted area larger than 2×3cm. Twenty of them were diagnosed as MI clinically, and 7. were overlooked. Six of 7 cases had the minor change in ECG. In all of 20 cases, in which diagnosis of MI was made clinically, the infarction larger than 2×3cm was proved. Infarction of smaller size was found in 6 cases, and 2 of them showed minor ECG change of MI.
In conclusion, the ECG findings of IMCS does not satisfy the criteria for MI, but minor changes were observed in not a few cases. These minor changes can be regarded as remains of old infarction from the autoptical studies. It is appropriate to alleviate the ECG criteria for MI, especially for old one.
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