The automated version of the complete Selvester QRS scoring system for estimation of myocardial infarct size was evaluated in 1,344 normal subjects, 706 patients with a single myocardial infarction (366 with inferior infarction, 277 with anterior infarction and 63 with posterolateral infarction) and 131 patients with combined inferior and anterior infarction. The presence and location were determined by angiographic and ventriculographic criteria. The performance of the overall 32-point system, each of the 19 criteria and the 13 criteria sets and each of the 35 criteria within the 13 sets was examined. The mean point scores were 1.7 for normal subjects, 3.7 for posterolateral infarction, 4.1 for inferior infarction, 6.3 for anterior infarction and 6.9 for multiple infarcts. A score greater than 4 yielded a sensitivity of 67% for anterior infarction, 41% for inferior infarction, 32% for posterolateral infarction and 72% for multiple infarcts. However, 7 of 32 criteria failed to achieve 95% specificity and 10 of 35 criteria in criteria sets had a sensitivity that was even lower than their false positive rate. The automated Selvester QRS scoring system currently has limitations that are attributable to development of the original system, which used manual scoring techniques and established criteria limits from middle-aged men. Future automated analysis should use gender- and age-dependent criteria limits.