Styliadis Ioannis, Ziakas Antonios, Karvounis Haralambos, Giannakoulas Georgios, Efthimiadis Georgios K, Parisiadou Anna, Anifanti Maria, Dalamanga Emmanouella, Parcharidis Georgios, Louridas Georgios
1st Department of Cardiology, AHEPA University Hospital, Thessaloniki, Greece.
J Emerg Med. 2008 Jul;35(1):67-72. doi: 10.1016/j.jemermed.2007.08.065. Epub 2008 Mar 4.
Prior studies have proposed several electrocardiogram criteria for identifying patients with acute inferior ST-segment elevation myocardial infarction (iSTEMI) caused by obstruction of the proximal part of the right coronary artery (RCA). We applied 11 of these criteria and three new ones to the admission electrocardiograms of 80 patients admitted with an acute iSTEMI in order to evaluate their utility. All patients received thrombolytic treatment and underwent coronary angiography during the hospitalization. Four previously described criteria (ST-segment depression in lead V1, ST-segment depression in leads V1-V3, maximum ST-segment depression in the precordial leads, and ST-segment depression in lead V3 of <or= 50% of the magnitude of ST-segment elevation in lead III) and two new used criteria (the absence of ST-segment depression in lead V1 in combination with ST-segment depression in lead V2 and the arithmetic sum of the ST-segment: III + V3 > 1) were useful in identifying patients with obstruction of the proximal part of the RCA. Among the six criteria, ST depression in V1-V3 had the highest specificity (77.2%) and positive predictive value (56.5%), and a new criterion-the arithmetic sum of the ST-elevation in V3/ST-elevation in III < 0.5--had the highest sensitivity (80.9%) and negative predictive value (86.7%). Six criteria were helpful in identifying patients with acute iSTEMI caused by obstruction of the proximal part of the RCA. One of these has not been previously reported and has the higher specificity and negative predictive value.
先前的研究提出了几种心电图标准，用于识别由右冠状动脉（RCA）近端阻塞引起的急性下壁ST段抬高型心肌梗死（iSTEMI）患者。我们将其中11种标准和3种新的标准应用于80例急性iSTEMI入院患者的入院心电图，以评估其效用。所有患者均接受了溶栓治疗，并在住院期间进行了冠状动脉造影。四个先前描述的标准（V1导联ST段压低、V1-V3导联ST段压低、胸前导联最大ST段压低以及V3导联ST段压低小于或等于III导联ST段抬高幅度的50%）和两个新使用的标准（V1导联无ST段压低且V2导联有ST段压低以及ST段算术和：III+V3>1）有助于识别RCA近端阻塞的患者。在这六个标准中，V1-V3导联ST段压低具有最高的特异性（77.2%）和阳性预测值（56.5%），而一个新的标准——V3导联ST段抬高/III导联ST段抬高的算术和<0.5——具有最高的敏感性（80.9%）和阴性预测值（86.7%）。六个标准有助于识别由RCA近端阻塞引起的急性iSTEMI患者。其中一个此前未被报道，具有较高的特异性和阴性预测值。
