Department of Emergency Medicine, University of Ulsan, Seoul, South Korea.
Am J Emerg Med. 2011 Nov;29(9):1067-73. doi: 10.1016/j.ajem.2010.06.033. Epub 2010 Sep 25.
Few studies specify the methods used to measure ST-segment elevation (STE). We therefore assessed differences in electrocardiography results depending on STE measurement methods for patients with inferior acute myocardial infarction (MI) and right ventricular infarction.
This study was a retrospective analysis. The STE group consisted of 88 patients consecutively admitted to the emergency department with inferior ST elevation MI associated with occlusion of right coronary artery or left circumflex coronary artery who underwent primary percutaneous coronary intervention. The control group consisted of 109 patients with non-ST elevation MI who had occlusion of right coronary artery or left circumflex coronary artery and underwent percutaneous coronary intervention. Measurements were performed at the J point and 60 milliseconds later for limb lead and right precordial V(4) lead (V4R). The criterion of at least 1-mm STE in 2 consecutive leads was applied, and the diagnostic accuracy of V4R was calculated.
In the STE group, the measurements 60 milliseconds after the J point were significantly higher than measurements at the J point at the II, III, aVF, and V4R leads. In the control group, only the measurements at lead I differed significantly. There was a 5% difference in diagnostic sensitivity depending on the measuring points in the STE group, a 1% to 3% difference in the control group, and a 10% to 11% difference at the V4R lead.
In patients with inferior MI, STE depends on the method of measurement, indicating a need for the standardization of measurements.
很少有研究具体说明测量 ST 段抬高（STE）的方法。因此，我们评估了用于测量下壁急性心肌梗死（MI）和右心室梗死患者 STE 的方法对心电图结果的差异。
本研究为回顾性分析。STE 组包括 88 例连续就诊于急诊科的下壁 ST 段抬高 MI 患者，这些患者的右冠状动脉或左回旋支冠状动脉闭塞，并接受了直接经皮冠状动脉介入治疗。对照组包括 109 例右冠状动脉或左回旋支冠状动脉闭塞并接受经皮冠状动脉介入治疗的非 ST 段抬高 MI 患者。肢体导联和右胸前 V4 导联（V4R）在 J 点和 60 毫秒后进行测量。应用至少 2 个连续导联出现 1mm STE 的标准，并计算 V4R 的诊断准确性。
在 STE 组中，J 点后 60 毫秒的测量值明显高于 II、III、aVF 和 V4R 导联的 J 点测量值。在对照组中，只有 I 导联的测量值有显著差异。在 STE 组中，根据测量点不同，诊断敏感性有 5%的差异，对照组有 1%至 3%的差异，V4R 导联有 10%至 11%的差异。
在下壁 MI 患者中，STE 取决于测量方法，表明需要对测量进行标准化。
