Kosuge Masami, Kimura Kazuo, Ishikawa Toshiyuki, Ebina Toshiaki, Shimizu Tomoaki, Hibi Kiyoshi, Toda Noritaka, Tahara Yoshio, Tsukahara Kengo, Kanna Masahiko, Okuda Jyunn, Nozawa Naoki, Ozaki Hiroyuki, Yano Hideto, Umemura Satoshi
The Division of Cardiology, Yokohama City University Medical Center, Yokohama, Japan.
Am J Cardiol. 2005 Jun 1;95(11):1366-9. doi: 10.1016/j.amjcard.2005.01.085.
To identify an early, simple, noninvasive predictor of left main (LM) or 3-vessel disease (3-VD), we retrospectively studied clinical variables on admission in 310 patients with acute coronary syndromes with non-ST-segment elevation. Univariate analysis indicated that many factors were related to LM/3-VD. Multivariate analysis showed that ST-segment elevation in lead aVR of >/=0.5 mm was the strongest predictor of LM/3-VD, followed by positive troponin T (odds ratio 19.7, p <0.001, and odds ratio 3.08, p = 0.048, respectively). ST-segment elevation in lead aVR of >/=0.5 mm and positive troponin T identified LM/3-VD with sensitivities of 78% and 62%, specificities of 86% and 59%, positive predictive values of 57% and 26%, and negative predictive values of 95% and 87%, respectively (p <0.05). Our findings suggest that in patients with non-ST-segment elevation acute coronary syndromes, ST-segment elevation in lead aVR of >/=0.5 mm and positive troponin T on admission (especially the former) are useful predictors of LM/3-VD.
为了确定左主干（LM）或三支血管病变（3-VD）的早期、简单、无创预测指标，我们回顾性研究了310例非ST段抬高型急性冠脉综合征患者入院时的临床变量。单因素分析表明，许多因素与LM/3-VD相关。多因素分析显示，aVR导联ST段抬高≥0.5 mm是LM/3-VD最强的预测指标，其次是肌钙蛋白T阳性（优势比分别为19.7，p<0.001和3.08，p = 0.048）。aVR导联ST段抬高≥0.5 mm和肌钙蛋白T阳性诊断LM/3-VD的敏感度分别为78%和62%，特异度分别为86%和59%，阳性预测值分别为57%和26%，阴性预测值分别为95%和87%（p<0.05）。我们的研究结果表明，在非ST段抬高型急性冠脉综合征患者中，入院时aVR导联ST段抬高≥0.5 mm和肌钙蛋白T阳性（尤其是前者）是LM/3-VD的有用预测指标。
