ECG criteria in diagnosis of acute myocardial infarction in the presence of left bundle branch block.
ECG criteria in diagnosis of acute myocardial infarction in the presence of left bundle branch block.
复制标题
存在左束支传导阻滞的急性心肌梗死的心电图诊断标准。
DOI：
10.1016/s0167-5273(01)00378-3
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发表时间：
2001
影响因子：
3.5
通讯作者：
M. Dellborg
中科院分区：
文献类型：
--
作者：
G. Gunnarsson;P. Eriksson;M. Dellborg
背景 存在左束支传导阻滞的急性心肌梗死的诊断很困难。最近提出了一种诊断性心电图评分系统，显示出良好的诊断能力。该评分系统从未经过前瞻性测试；我们已经这样做了，并调查了它是否可能具有预后信息。方法一项前瞻性多中心研究。连续出现左束支传导阻滞并怀疑急性心肌梗塞的患者入住瑞典 14 家冠状动脉监护病房。招募时间为1996年3月至1997年12月。入院时和12-24小时后记录心电图。结果纳入158名患者，平均年龄74.9岁。 76 名患者 (48%) 患有急性心肌梗死。提议的心电图评分系统诊断急性心肌梗死的总分≥3分的敏感性为17.1%（95% CI 8.6-25.6%），特异性为94.0%（95% CI 88.9-99.1%）。急性心肌梗死的临床判断敏感性为 15.8% (95% CI 7.6–24%)，特异性为 96.0% (CI 92.3–100%)。心电图总分≥3分与总分<3分的患者3个月或1年生存率无差异。结论心电图标准的诊断能力较低，并不优于临床判断。因此，该标准不适用于筛查存在左束支传导阻滞的疑似急性心肌梗死患者，也不适用于识别高危患者。
BackgroundThe diagnosis of acute myocardial infarction in the presence of left bundle branch block is difficult. Recently a diagnostic ECG scoring system was suggested, showing good diagnostic abilities. This scoring system has never been tested in a prospective manner; we have done so and investigated if it might bear prognostic information.MethodsA prospective multi-centre study. Consecutive patients with left bundle branch block and suspicion of acute myocardial infarction, admitted to 14 Swedish coronary care units. Recruitment from March 1996 to December 1997. ECG registered on admission and after 12–24 h.ResultsOne hundred and fifty-eight patients were included, mean age 74.9 years. Seventy-six patients (48%) had an acute myocardial infarction. The proposed cut-off total score of ≥3 of the ECG scoring system for the diagnosis of acute myocardial infarction had a sensitivity of 17.1% (95% CI 8.6–25.6%) and specificity of 94.0% (95% CI 88.9–99.1%). Clinical judgement of acute myocardial infarction resulted in a sensitivity of 15.8% (95% CI 7.6–24%) and specificity of 96.0% (CI 92.3–100%). No difference was seen in 3-month or 1-year survival between those with total ECG score ≥3 versus total score <3.ConclusionThe diagnostic abilities of the proposed ECG criteria are low and not better than the clinical judgement. The criteria are therefore not suitable for screening patients with suspicion of acute myocardial infarction in the presence of left bundle branch block, nor do they seem to identify high risk patients.