The diagnosis of myocardial infarction in critically ill patients: An agreement study

Wendy Lim, Andrea Tkaczyk, Paula Holinski, Ismael Qushmaq, Michael Jacka, Vikas Khera, P. J. Devereaux, Irene Terrenato, Holger Schunemann, Diane Heels-Ansdell, Mark Crowther, Deborah Cook

Research output: Contribution to journalArticlepeer-review


Purpose: The aim of the study was to assess agreement among 4 intensivists in diagnosing myocardial infarction (MI) in critically ill patients based on screening electrocardiograms (ECGs) and cardiac troponin (cTn) levels. Methods: Consecutive patients admitted to a medical-surgical intensive care unit (ICU) underwent systematic screening with 12-lead ECGs and cTn measurements throughout their ICU stay. Independently, 4 raters interpreted the ECGs assessing for changes indicative of ischemia and then classified each patient as to whether they met diagnostic criteria for MI based on the screening cTn measurements and ECG results. A priori, 2 raters were designated the primary adjudicators, and their consensus was used as the reference for the agreement statistics. Agreement on MI diagnosis was calculated for the 4 raters and expressed as raw agreement, κ (chance-corrected agreement) and φ{symbol} (chance-independent agreement, calculated using pairs). Results: Among 103 enrolled patients, 37 (35.9%) had MI according to the primary adjudicators. The raw agreement for diagnosing MI was 79% (substantial), κ was 0.24 (fair), and φ{symbol} ranged from 0.12 to 0.73 (slight to substantial). Conclusions: Diagnosing MI in the ICU remains a challenge due to variable agreement in 12-lead ECG interpretation. Such variation in practice may contribute to underrecognition of MI during critical illness.

Original languageEnglish
Pages (from-to)447-452
Number of pages6
JournalJournal of Critical Care
Issue number3
Publication statusPublished - Sep 2009


  • Critical illness
  • Decision making
  • Electrocardiography
  • Intensive care unit
  • Troponin

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine


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