The Anderson-Wilkins (AW) electrocardiographic (ECG) acuteness score complements time from pain onset in prognostic stratification of patients with acute myocardial infarction (AMI). However, for the AW acuteness score to be of practical use in the acute situation, it must be an integral component of a commercial automated ECG analysis program. The objective of this study was to determine the concordance between human and computer measurements and calculation of the AW acuteness score. The mean difference in AW acuteness score was 0.11 +/- 0.66 for anterior and -0.07 +/- 1.24 for inferior AMI. Ninety-nine percent of the differences were found to be 1.0 or less for the anterior AMI group, and 91.7% were 1.0 or less in the inferior AMI group. The differences were primarily caused by minor disagreements in measurements. In conclusion, the AW acuteness score established using manual ECG waveform measurements can be implemented into commercial automated ECG analysis programs to achieve practical use in clinical decision support for patients with AMI.