Autopsy represents the best opportunity for clinicians to check their diagnostic certainty. The necessity of performing an autopsy to determine the underlying cause of death has been questioned with the advent of more sophisticated diagnostic methods. Since myocardial infarction is the most frequent cause of death in Western countries, we evaluated the frequency of identity of clinical and autopsy diagnosis in 1595 patients in whom myocardial infarction was clinically supposed to be the cause of death.
Clinical diagnosis of myocardial infarction was based on the following classical criteria: chest pain similiar to angina pectoris but more intense and persistent, which was not fully relieved by taking nitroglycerins. This was often accompanied by vegetative symptoms such as vomiting, nausea or sweating. The diagnosis was further based on ECG-abnormalities. These were, in case of Q-wave myocardial infarction, ST elevation followed by T-wave inversion and consecutive Q-development, or ST depression followed by persistent ST-T wave changes without Q-wave development in "non-Q-wave" myocardial infarction. Myocardial infarction was further confirmed by typical changes of the serum concentrations of the enzymes CK (CK-MIB), LDH and ASR, respectively.
However, in many cases the diagnosis of myocardial infarction is more sophisticated, e.g. in patients with bundle blocks or pacemakers, where usage of ECG for identification of myocardial infarction is limited. If patients died immediately after having myocardial infarction, no changes in serum enzyme activity could be observed due to the shortness of delay. In such cases the diagnosis was often based on the occurrence of typical clinical symptoms. However, -25% of all myocardial