Zabel M, Hohnloser S H, Parussel A, Just H
University of Freiburg, Department of Cardiology, Germany.
Eur Heart J. 1992 Dec;13(12):1619-25. doi: 10.1093/oxfordjournals.eurheartj.a060114.
In a prospective trial in 124 patients with acute myocardial infarction, Holter and surface ECG recordings were obtained simultaneously and compared for their ability to assess thrombolysis-induced ST segment changes. Accuracy in predicting patency of the infarct-related artery was evaluated in both methods. Success or failure of thrombolysis was determined angiographically 90 min after the start of therapy. For both methods, sensitivity, specificity, and positive predictive value for correct prediction of the perfusion status ranged between 64% and 92%. However, the negative predictive value was considerably lower (40-53%). There were no significant differences in any parameter evaluated for either method. Thus, two surface ECG recordings before and 2 h after the start of therapy yield the same predictive value as continuous Holter monitoring with respect to thrombolysis-induced coronary artery reperfusion. However, for triage of patients to early coronary interventions, more sophisticated methods are needed for non-invasive prediction of coronary artery patency due to the low negative predictive value of ST segment analysis.
在一项针对124例急性心肌梗死患者的前瞻性试验中，同时获取了动态心电图（Holter）记录和体表心电图记录，并比较了它们评估溶栓诱导的ST段变化的能力。两种方法均评估了预测梗死相关动脉通畅情况的准确性。在治疗开始90分钟后通过血管造影确定溶栓成功或失败。对于两种方法，正确预测灌注状态的敏感性、特异性和阳性预测值在64%至92%之间。然而，阴性预测值相当低（40 - 53%）。两种方法评估的任何参数均无显著差异。因此，在治疗开始前和开始后2小时进行的两次体表心电图记录，在溶栓诱导的冠状动脉再灌注方面与连续动态心电图监测具有相同的预测价值。然而，由于ST段分析的阴性预测值较低，对于将患者分流至早期冠状动脉干预，需要更复杂的方法来无创预测冠状动脉通畅情况。
