Subtle Anterior STEMI Calculator (4-Variable)
Differentiates subtle anterior STEMI (LAD occlusion) from normal-variant ST elevation (early repolarisation) using QTc, QRS amplitude in V2, R-wave amplitude in V4 and ST elevation 60 ms after the J-point in V3 (Driver 2017 4-variable formula). A value ≥ 18.2 favours LAD occlusion.
Score interpretation
Formula value below 18.2: normal-variant ST elevation (early repolarisation) more likely (Driver 2017).
→ Does not exclude occlusion: serial ECGs and troponins; act on clinical suspicion.
Formula value 18.2 or more: subtle LAD occlusion likely (sensitivity 88.8 %, specificity 94.7 % in the derivation set).
→ Urgent cardiology discussion for emergency angiography per the local STEMI / occlusion MI pathway.
Interpretation bands for the Subtle STEMI. Apply clinical judgement and local guidance.
References
- Driver BE, Khalil A, Henry T, et al. A new 4-variable formula to differentiate normal variant ST segment elevation in V2–V4 (early repolarization) from subtle left anterior descending coronary occlusion — adding QRS amplitude of V2 improves the model. J Electrocardiol. 2017;50(5):561–569.
- Smith SW, Khalil A, Henry TD, et al. Electrocardiographic differentiation of early repolarization from subtle anterior ST-segment elevation myocardial infarction. Ann Emerg Med. 2012;60(1):45–56.
Related
Curated clinical cross-links plus same-class fallbacks.
- HEART Score for Major Adverse Cardiac Events · Chest Pain
- EDACS — Emergency Department Assessment of Chest Pain · Chest Pain
- HEAR Score for Acute Chest Pain · Chest Pain
- ACTION ICU Score for Intensive Care in NSTEMI · Chest Pain
- Marburg Heart Score · Chest Pain
- INTERCHEST Clinical Prediction Rule · Chest Pain
- Alteplase (STEMI Thrombolysis) · Thrombolytic / STEMI
- Streptokinase (STEMI Thrombolysis) · Thrombolytic / STEMI
- Methoxyflurane · Inhaled Analgesic — Acute Pain
- Fentanyl Transdermal Patch (Elderly Chronic Pain) · Opioid Analgesic — Transdermal Patch
- Morphine Slow-Release (Elderly Chronic Pain) · Opioid Analgesic — Modified-Release Oral
- Amitriptyline (Neuropathic Pain / Migraine) · Tricyclic Antidepressant / Neuropathic Pain Agent
- Acute Heart Failure · ESC 2021 Heart Failure Guidelines; NICE NG106
- NSTEMI / Unstable Angina · ESC 2020 NSTEMI Guidelines; NICE NG185
- New-Onset Atrial Fibrillation · ESC 2020 AF Guidelines; NICE NG196
- Hypertensive Emergency · ESC/ESH 2018 Hypertension Guidelines; NICE NG136
- Bradycardia Management · Resuscitation Council UK ABCDE; ESC 2021 Pacing Guidelines
- Ventricular Tachycardia / Fibrillation · Resuscitation Council UK ACLS; ESC 2022 Ventricular Arrhythmia Guidelines
Decision support only — verify against a current formulary, NICE, or your local guideline before clinical use.