Acute Detection of ST-Elevation Myocardial Infarction Missed on Standard 12-Lead ECG With a Novel 80-Lead Real-Time Digital Body Surface Map: Primary Results From the Multicenter OCCULT MI Trial
Acute Detection of ST-Elevation Myocardial Infarction Missed on Standard 12-Lead ECG With a Novel 80-Lead Real-Time Digital Body Surface Map: Primary Results From the Multicenter OCCULT MI Trial
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DOI：
10.1016/j.annemergmed.2009.06.525
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发表时间：
2009-12-01
影响因子：
6.2
通讯作者：
Krucoff, Mitchell
中科院分区：
文献类型：
--
作者：
Hoekstra, James W.;O'Neill, Brian J.;Krucoff, Mitchell
研究目的：虽然80导联心电图体表标测对st段抬高型心肌梗死（STEMI）比12导联心电图更敏感，但其在急诊科（ED）胸痛中的临床应用尚未得到研究。我们试图确定80导联而非12导联（仅80导联）STEMI患者的患病率、临床护理模式和临床结果。方法：最佳心血管诊断评估使心肌梗死更快治疗试验是一项多中心前瞻性观察研究，研究对象是出现在急诊科的中至高危胸痛患者。患者同时接受12导联和80导联心电图作为初始评估的一部分，并根据标准护理进行治疗，临床医生对80导联结果不知情。该试验的主要结局是仅80导联的STEMI患者与仅12导联的STEMI患者（12导联STEM）的门到鞘时间。次要结果包括血管造影和30天的临床结果。结果：共评估1330例患者，91例患者出院诊断为12导联STEMI， 25例患者符合仅80导联STEMI标准。91例12导联STEMI患者中有84例接受了心导管插入术，从门到鞘鞘的中位数时间为54分钟，而25例仅80导联STEMI患者中有14例接受了心导管插入术，从门到鞘鞘的时间为1002分钟（估计治疗差异中位数=881；95%置信区间为181 ~ 1079分钟）。然而，80例仅导联的STEMI和12例导联的STEMI患者的临床结果和血运重建率相似。结论：与12导联相比，80导联心电图的STEMI检出率增加了27.5%。仅80导联的STEMI患者的不良后果与12导联的STEMI患者相似，但治疗均采用延迟或保守的侵入性策略。[j] .中华急诊医学杂志。2009;54:779-788。
Study objective: Although 80-lead ECG body surface mapping is more sensitive for ST-elevation myocardial infarction (STEMI) than the 12-lead ECG, its clinical utility in chest pain in the emergency department (ED) has not been studied. We sought to determine the prevalence, clinical care patterns, and clinical outcomes of patients with STEMI identified on 80-lead but not on 12-lead (80-lead-only STEMI).Methods: The Optimal Cardiovascular Diagnostic Evaluation Enabling Faster Treatment of Myocardial Infarction trial was a multicenter prospective observational study of moderate- to high-risk chest pain patients presenting to the ED. Patients received simultaneous 12-lead and 80-lead ECGs as part of their initial evaluation and were treated according to the standard of care, with clinicians blinded to the 80-lead results. The primary outcome of the trial was door-to-sheath time in patients with 80-lead-only STEMI versus patients with STEMI identified by 12-lead alone (12-lead STEM]). Secondary outcomes included angiographic and clinical outcomes at 30 days.Results: One thousand eight hundred thirty patients were evaluated, 91 had a discharge diagnosis of 12-lead STEMI, and 25 patients met criteria for 80-lead-only STEMI. Eighty-four of the 91 12-lead STEMI patients underwent cardiac catheterization, with a median door-to-sheath time of 54 minutes, versus 14 of the 25 80-lead-only STEMI patients, with a door-to-sheath time of 1,002 minutes (estimated treatment difference in median=881; 95% confidence interval 181 to 1,079 minutes). Clinical outcomes and revascularization rates, however, were similar between 80-lead-only STEMI and 12-lead STEMI patients.Conclusion: The 80-lead ECG provides an incremental 27.5% increase in STEMI detection versus the 12-lead. Patients with 80-lead-only STEMI have adverse outcomes similar to those of 12-lead STEMI patients but are treated with delayed or conservative invasive strategies. [Ann Emerg Med. 2009;54:779-788.]