Grimm K Twerenbold R Abaecherli R Boeddinghaus J Nestelberger T Koechlin L Troester V Bourtzou A Keller DI Geigy N Kozhuharov N Wussler D Wildi K Hillinger P Rubini Giménez M Strebel I Badertscher P Puelacher C du Fay de Lavallaz J Osswald L Morawiec B Kawecki D Miró Ò Kühne M Reichlin T Mueller C 2020 BACKGROUND Recent advances in digital electrocardiography technology allow evaluating ST-segment deviations in all 12 leads as quantitative variables and calculating summed ST-segment deviation scores. The diagnostic and prognostic utility of summed ST-segment deviation scores is largely unknown. METHODS We aimed to explore the diagnostic and prognostic utility of the conventional and the modified ST-segment deviation score (Better Analysis of ST-segment Elevations and Depressions in a 12- Lead-ECG-Score (BASEL-Score): sum of elevations in the augmented voltage right - lead (aVR) plus absolute, unsigned ST-segment depressions in the remaining leads) in patients presenting with suspected non-ST-segment elevation myocardial infarction. The diagnostic endpoint was non-ST-segment elevation myocardial infarction, adjudicated by two independent cardiologists. Prognostic endpoint was mortality during two-year follow up. RESULTS Among 1330 patients, non-ST-segment elevation myocardial infarction was present in 200 (15%) patients. Diagnostic accuracy for non-ST-segment elevation myocardial infarction as quantified by the area under the receiver-operating-characteristics curve was significantly higher for the BASEL-Score (0.73; 95% confidence interval 0.69-0.77) as compared to the conventional ST-segment deviation score (0.53; 95% confidence interval 0.49-0.57, p<0.001). The BASEL-Score provided additional independent diagnostic value to dichotomous electrocardiogram variables (ST-segment depression, T-inversion, both p<0.001) and to high-sensitivity cardiac troponin (p<0.001) as well as clinical judgment at 90 min (p<0.001). Similarly, only the BASEL-Score proved to be an independent predictor of two year mortality. CONCLUSIONS The modified ST-segment deviation score BASEL-Score focusing on ST-segment elevation in aVR and ST-segment depressions in the remaining leads provides incremental diagnostic and prognostic information. https://sonar.ch/global/documents/351 eng info:eu-repo/semantics/altIdentifier/doi/10.1177/2048872619853579 info:eu-repo/semantics/altIdentifier/pmid/31976746 European heart journal. Acute cardiovascular care. - 2020 Acute coronary syndrome ST-segment deviation electrocardiogram Diagnostic and prognostic value of ST-segment deviation scores in suspected acute myocardial infarction. http://purl.org/coar/resource_type/c_6501