USEFULNESS OF ST-SEGMENT CHANGES IN GREATER-THAN-OR-EQUAL-TO-2 LEADS ON THE EMERGENCY ROOM ELECTROCARDIOGRAM IN EITHER UNSTABLE ANGINA-PECTORIS OR NON-Q-WAVE MYOCARDIAL-INFARCTION IN PREDICTING OUTCOME
USEFULNESS OF ST-SEGMENT CHANGES IN GREATER-THAN-OR-EQUAL-TO-2 LEADS ON THE EMERGENCY ROOM ELECTROCARDIOGRAM IN EITHER UNSTABLE ANGINA-PECTORIS OR NON-Q-WAVE MYOCARDIAL-INFARCTION IN PREDICTING OUTCOME
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DOI：
10.1016/0002-9149(91)90467-y
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发表时间：
1991-06-15
影响因子：
2.8
通讯作者：
FUSTER, V
中科院分区：
文献类型：
--
作者：
COHEN, M;HAWKINS, L;FUSTER, V
为了确定入院心电图在预测因静息胸痛住院患者预后方面的可靠性，90例患者被随机分配到一项阿司匹林与肝素治疗不稳定型心绞痛或非Q波心肌梗死的试验中，并前瞻性随访3个月。 分析急诊室入院心电图ST段偏移≥ 1 mm/导联和T波变化。 不良结局为缺血性疼痛复发、心肌梗死和冠状动脉血管成形术或手术重建。 在接受冠状动脉造影术的患者中，根据直径狭窄大于或等于70%的血管数量和狭窄位置，将危险心肌评分范围从0到10。 考虑到所有90例患者，入院心电图ST段偏移大于或等于2导联对不良临床事件的阳性预测值为79%，阴性预测值为64%。 在无左心室肥厚且入院时记录胸痛心电图的患者亚组中（62/90），ST段偏移大于或等于2导联的阳性预测值提高至89%，阴性预测值提高至72%。 62例患者中，53例接受了冠状动脉造影。 ST段偏移的导联数与危险心肌评分呈直线正相关（r = 0.80，p < 0.001）。 在不稳定型心绞痛或非Q波心肌梗死患者中，疼痛时记录的入院心电图显示ST段改变大于或等于2导联本身就是主要临床事件的可靠预测因素。 ST段改变的导联总数可预测心肌受损的程度。
To determine the reliability of the admission electrocardiogram in predicting outcome in patients hospitalized for chest pain at rest, 90 patients were randomized into a trial of aspirin versus heparin in unstable angina or non-Q-wave myocardial infarction, and prospectively followed for 3 months. The emergency room admission electrocardiogram was analyzed for ST-segment deviation greater-than-or-equal-to 1 mm/lead and T-wave changes. Unfavorable outcomes were recurrent ischemic pain, myocardial infarction and coronary revascularization with angioplasty or surgery. In patients who underwent coronary arteriography, a myocardium in jeopardy score ranging from 0 to 10 was assigned, based on the number of vessels with a diameter stenosis greater-than-or-equal-to 70% and the location of the stenoses. Considering all 90 patients, an admission electrocardiogram with ST-segment deviation in greater-than-or-equal-to 2 leads had a positive predictive value for adverse clinical events of 79% and a negative predictive value of 64%. In the subset of patients without left ventricular hypertrophy and whose admission electrocardiograms were recorded during chest pain (62 of 90), the positive predictive value of ST deviation in greater-than-or-equal-to 2 leads improved to 89% and the negative value to 72%. Of the 62 patients, 53 underwent coronary arteriography. There was a positive linear correlation between the total number of leads with ST-segment deviation and the myocardium in jeopardy score (r = 0.80, p < 0.001). In patients with unstable angina or non-Q-wave myocardial infarction, an admission electrocardiogram recorded during pain and revealing ST-segment changes in greater-than-or-equal-to 2 leads is by itself a reliable predictor of major clinical events. The total number of leads with ST changes predicts the extent of myocardium in jeopardy.