Criteria for Significant Electrocardiographic Change

The Minnesota Code was originally developed for determining prevalence information in populations. Later, in an attempt to document incident events, criteria were developed to document significant ECG changes that were based on apparent changes in the Minnesota Code of sequential ECGs. However, because the Minnesota Code is categorical and ECG parameters are continuous, this approach yielded high false positive misclassifications as judged by clinical assessment. We realized that a new and quantitative approach was required to overcome the deficiencies of categorical Minnesota Code change. We developed a compilation of procedures and rules for serial comparison that took into account the limitations of the previous Minnesota Code change criteria by requiring side-by-side, or direct comparison of reference and follow-up ECGs, rather than relying solely on direct categorical change in Minnesota Codes. This method simulates the clinician's approach for comparing ECGs, but includes a standardized method for documenting significant ECG pattern change. Just as the original Minnesota Code uses specified measurement rules to reduce coding variability and a systematic classification code based on these measurements, serial comparison uses a set of measurement rules and a systematic classification code to document categories of ECG pattern changes.