The Cardiovascular
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Subtle Anterior STEMI Calculator (4-Variable)

Distinguishes subtle anterior LAD occlusion from benign early repolarization.

Subtle Anterior STEMI Calculator (4-Variable)
ST elevation 60 ms after J-point in V3
mm
Computer-derived Bazett-corrected QTc
QRS amplitude in V2
mm
R-wave amplitude in V4
mm
Complete the fields above to see the result.

When to use

  • Suspected subtle anterior STEMI when V2-V4 ST elevation could represent early repolarization.
  • Not for use with overt STEMI, LVH, LBBB, or pericarditis patterns.

Formula

Score = 1.062 x STE60V3(mm) + 0.052 x QTc(ms) - 0.151 x QRSV2(mm) - 0.268 x RAV4(mm). >=18.2 suggests LAD occlusion.

Pearls and pitfalls

  • Improves on the original 3-variable formula by adding QRS amplitude in V2.
  • Derived and validated in patients with V2-V4 ST elevation and chest pain; not for use outside this pattern.

References

  1. Driver BE, et al. J Electrocardiol. 2017;50(5):561-9.