Lurati Buse Giovanna A, Seeberger Manfred D, Schumann Regina M, Bürgler David, Schwab Hildebrand S, Bolliger Daniel, Filipovic Miodrag
Department of Anesthesia, University of Basel, CH-4031 Basel, Switzerland.
J Electrocardiol. 2009 Sep-Oct;42(5):455-461.e1. doi: 10.1016/j.jelectrocard.2009.05.008.
Preexisting electrocardiographic abnormalities may limit accuracy of continuous electrocardiography (cECG) for ischemia determination. The American College of Cardiology/American Heart Association published criteria for the exclusion of unsuitable cECG curves from ST-segment interpretation. These criteria consider medication and 12-lead ECG findings (medication- and 12-lead ECG-based criteria) and cECG lead characteristics (cECG-based criteria).
We recorded cECG in 300 patients undergoing major noncardiac surgery. We determined postoperative troponin and 12-month outcome. We compared the associations of cECG-detected ischemia with troponin and 12-month outcome with and without adherence to the criteria.
Adherence to the medication- and 12-lead ECG-based criteria enhanced the association between troponin and perioperative ischemia in CM5 (odds ratio, 3.74; 95% confidence interval, 1.88-7.44) and 7.03 (2.67-18.49), respectively; P = .049). Similarly, the association between ischemia in CM5 and 12-month outcome tended to increase (P = .081).
Applying the guideline criteria for the interpretation of cECG enhanced cECG diagnostic value in surgical patients.
既往心电图异常可能会限制连续心电图（cECG）用于确定缺血的准确性。美国心脏病学会/美国心脏协会发布了从ST段解读中排除不合适cECG曲线的标准。这些标准考虑了用药情况和12导联心电图结果（基于用药和12导联心电图的标准）以及cECG导联特征（基于cECG的标准）。
我们记录了300例接受非心脏大手术患者的cECG。我们测定了术后肌钙蛋白和12个月的预后情况。我们比较了遵循和未遵循这些标准时，cECG检测到的缺血与肌钙蛋白以及12个月预后之间的关联。
遵循基于用药和12导联心电图的标准分别增强了CM5导联中肌钙蛋白与围手术期缺血之间的关联（比值比，3.74；95%置信区间，1.88 - 7.44）以及7.03（2.67 - 18.49）；P = 0.049）。同样，CM5导联缺血与12个月预后之间的关联也有增加趋势（P = 0.081）。
应用cECG解读的指南标准可提高cECG在手术患者中的诊断价值。
