Body surface mapping vs 12-lead electrocardiography to detect ST-elevation myocardial infarction
Body surface mapping vs 12-lead electrocardiography to detect ST-elevation myocardial infarction
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DOI：
10.1016/j.ajem.2008.06.010
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发表时间：
2009-09-01
影响因子：
3.6
通讯作者：
Adgey, Jennifer
中科院分区：
文献类型：
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作者：
Ornato, Joseph P.;Menown, Ian B. A.;Adgey, Jennifer
在4家医院的非创伤性胸痛患者中进行了一项前瞻性、多中心试验，以确定在急诊室（艾德）环境中，与标准12导联心电图（ECG）相比，80导联体表标测心电图系统（80导联BSM ECG）是否能改善急性心肌梗死（STEMI）ST段抬高的检测。由经过培训的艾德或心脏病学工作人员（技术员或护士）记录每例受试者在初次就诊时的12导联ECG和80导联BSM ECG。根据各医院的实践获得了系列生物标志物（总肌酸激酶[CK]、CK-MB和/或肌钙蛋白）。在评价的647例患者中，589例有可用的生物标志物结果。与CK-MB定义的STEMI（100% vs 72.7%，P = 0.031; n = 364）或肌钙蛋白定义的STEMI（92.9% vs 60.7%，P = 0.022; n = 225）的12导联ECG相比，80导联BSM ECG改善了生物标志物证实的STEMI的检测。STEMI的特异性较高（范围94.9%-97.1%），80导联BSM ECG和12导联ECG之间无显著差异。在9例CK-MB定义的MI患者中，2例（22%）和9例肌钙蛋白定义的MI患者中，通过80导联BSM ECG检测到右心室受累并发下壁STEMI。12导联心电图最常漏诊的梗死部位是下后壁心肌梗死，而80导联BSM心电图最常漏诊的部位是下后壁心肌梗死。我们得出结论，使用80导联BSM ECG的BSM比12导联ECG更敏感地检测STEMI，同时保持相似的特异性。(C)2009 Elsevier Inc. All rights reserved.
A prospective, multicenter trial was conducted in patients with nontraumatic chest pain in 4 hospitals to determine whether an 80-lead body surface map electrocardiogram system (80-lead BSM ECG) improves detection of ST-segment elevation in acute myocardial infarction (STEMl) compared with a standard 12-lead electrocardiogram (ECG) in an emergency department (ED) setting. A trained ED or cardiology staff member (technician or nurse) recorded a 12-lead ECG and 80-lead BSM ECG from each subject at initial presentation. Serial biomarkers (total creatine kinase [CK], CK-MB, and/or troponin) were obtained according to individual hospital practice. Of the 647 patients evaluated, 589 had available biomarkers results. Eighty-lead BSM ECG improved detection of biomarker-confirmed STEMI compared with the 12-lead ECG for CK-MB-defined STEMI (100% vs 72.7%, P = .031; n = 364) or troponin-defined STEMI (92.9% vs 60.7%, P = .022; n = 225). Specificity for STEMI was high (range, 94.9%-97.1%) with no significant difference between 80-lead BSM ECG and 12-lead ECG. Right ventricular involvement complicating inferior STEMI was detected by 80-lead BSM ECG in 2 (22%) of 9 patients with CK-MB-defined MI and in 2 (22%) of 9 patients with troponin-defined MI. The infarct location missed most commonly on 12-lead ECG but detected by 80-lead BSM ECG was inferoposterior MI. We conclude that BSM using 80-lead BSM ECG is more sensitive for detection of STEMI than 12-lead ECG, while retaining similar specificity. (C) 2009 Elsevier Inc. All rights reserved.