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To the Editor: While the article by Dr Panju and colleagues¹ on diagnosing myocardial infarction (MI) was excellent, patients with cardiac conditions should be reminded to carry a copy of their electrocardiogram (ECG). In our splintered current health care system, this step would save much time and effort and permit appropriate therapy to be instituted more quickly.

Neil L. Kao, MD
Dayton, Ohio

1. Panju AA, Hemmelgarn BR, Guyatt GH, Simel DL. Is this patient having a myocardial infarction? JAMA. 1998;280:1256-1263. FREE FULL TEXT

In Reply: We thank Dr Kao for his thoughtful comments and agree that the ECG, and specifically the presence of new ST-segment elevation and new Q waves, plays an important role in aiding the diagnosis of MI. In particular in our review we found that the presence of a new ST-segment elevation was associated with likelihood ratios of 5.7 to 53.9, while the presence of any ST-segment elevation (which by definition includes ST-segment elevation that may have been present on a prior ECG) was associated with a . . . [Full Text of this Article]