Abstract

Objectives

To evaluate the diagnostic yield of the ECG criteria for ST-elevation myocardial infarction in a large cohort of emergency department chest pain patients, and to determine whether extended ECG criteria or reciprocal ST depression can improve accuracy. Design: Observational, register-based diagnostic study on the accuracy of ECG criteria for ST-elevation myocardial infarction. Between Jan 2010 and Dec 2014 all patients aged ≥30 years with chest pain who had an ECG recorded within 4 h at two emergency departments in Sweden were included. Exclusion criteria were: ECG with poor technical quality; QRS duration ≥120 ms; ECG signs of left ventricular hypertrophy; or previous coronary artery bypass surgery. Conventional and extended ECG criteria were applied to all patients. The main outcome was acute myocardial infarction (AMI) and an occluded/near-occluded coronary artery at angiography. Results: Finally, 19932 patients were included. Conventional ECG criteria for ST elevation myocardial infarction were fulfilled in 502 patients, and extended criteria in 1249 patients. Sensitivity for conventional ECG criteria in diagnosing AMI with coronary occlusion/near-occlusion was 17%, specificity 98% and positive predictive value 12%. Corresponding data for extended ECG criteria were 30%, 94% and 8%. When reciprocal ST depression was added to the criteria, the positive predictive value rose to 24% for the conventional and 23% for the extended criteria. Conclusions: In unselected chest pain patients at the emergency department, the diagnostic yield of both conventional and extended ECG criteria for ST-elevation myocardial infarction is low. The PPV can be increased by also considering reciprocal ST depression.

中文翻译：

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急诊胸痛患者ST段抬高心肌梗死幅度标准诊断率低

摘要

目标

评估 ECG 标准对大量急诊科胸痛患者的 ST 段抬高心肌梗死的诊断率，并确定扩展 ECG 标准或相互 ST 压低是否可以提高准确性。设计：关于 ST 段抬高心肌梗死 ECG 标准准确性的观察性、基于注册的诊断研究。2010 年 1 月至 2014 年 12 月期间，所有年龄≥30 岁的胸痛患者均在瑞典的两个急诊科进行了 4 小时内记录的心电图记录。排除标准为：心电图技术质量差；QRS 持续时间≥120 ms；左心室肥厚的心电图征象；或以前的冠状动脉搭桥手术。常规和扩展心电图标准适用于所有患者。主要结果是急性心肌梗死 (AMI) 和血管造影时冠状动脉闭塞/接近闭塞。结果：最后，包括 19932 名患者。502 名患者符合 ST 段抬高心肌梗死的常规心电图标准，1249 名患者符合扩展标准。使用常规心电图标准诊断冠状动脉闭塞/接近闭塞的 AMI 的敏感性为 17%，特异性为 98%，阳性预测值为 12%。扩展心电图标准的相应数据为 30%、94% 和 8%。当将相互 ST 压低加入标准时，常规标准的阳性预测值上升至 24%，扩展标准的阳性预测值上升至 23%。结论：在急诊科未经选择的胸痛患者中，常规和扩展心电图标准对 ST 段抬高心肌梗死的诊断率较低。还可以通过考虑相互 ST 压低来增加 PPV。