以首份心电图结果不具诊断性的 ST 段抬高型心肌梗死患者的诊断时间进程、治疗和院内结局：美国心脏协会生命线计划的报告。
Diagnostic time course, treatment, and in-hospital outcomes for patients with ST-segment elevation myocardial infarction presenting with nondiagnostic initial electrocardiogram: a report from the American Heart Association Mission: Lifeline program.
机构信息
Section on Cardiology, Wake Forest University Health Sciences, Winston-Salem, NC 27157, USA.
出版信息
Am Heart J. 2013 Jan;165(1):50-6. doi: 10.1016/j.ahj.2012.10.027. Epub 2012 Nov 21.
BACKGROUND
Prior studies indicate that a subset of patients diagnosed as having ST-segment elevation myocardial infarction (STEMI) will have an initial non-diagnostic electrocardiogram (ECG) during evaluation. However, the timing of diagnostic ECG changes in this group is unknown. Our primary aim was to describe the timing of ECG diagnosis of STEMI in patients whose initial ECG was non-diagnostic. Secondarily, we sought to compare the delivery of American College of Cardiology/American Heart Association guidelines-based care and in-hospital outcomes in this group compared with patients diagnosed as having STEMI on initial ECG.
METHODS
We analyzed data from 41,560 patients diagnosed as having STEMI included in the National Cardiovascular Data Registry ACTION Registry-GWTG from January 2007 to December 2010. We divided this study population into 2 groups: those diagnosed on initial ECG (N = 36,994) and those with an initial non-diagnostic ECG that were diagnosed on a follow-up ECG (N = 4,566).
RESULTS
In general, baseline characteristics and clinical presentations were similar between the 2 groups. For patients with an initial non-diagnostic ECG, 72.4% (n = 3,305) had an ECG diagnostic for STEMI within 90 minutes of their initial ECG. There did not appear to be significant differences in the administration of guideline-recommended treatments for STEMI, in-hospital major bleeding (P = .926), or death (P = .475) between these groups.
CONCLUSIONS
In a national sample of patients diagnosed as having STEMI, 11.0% had an initial non-diagnostic ECG. Of those patients, 72.4% had a follow-up diagnostic ECG within 90 minutes of their initial ECG. There did not appear to be clinically meaningful differences in guidelines-based treatment or major inhospital outcomes between patients diagnosed as having STEMI on an initial ECG and those diagnosed on a follow-up ECG.
背景
先前的研究表明，一部分被诊断为 ST 段抬高型心肌梗死（STEMI）的患者在评估期间最初的心电图（ECG）可能无诊断意义。然而，该类患者心电图诊断改变的时间尚不清楚。我们的主要目的是描述最初 ECG 无诊断意义的 STEMI 患者的心电图诊断时间。其次，我们试图比较该组患者与最初 ECG 诊断为 STEMI 的患者在接受美国心脏病学会/美国心脏协会指南为基础的治疗和住院期间结局方面的差异。
方法
我们分析了 2007 年 1 月至 2010 年 12 月期间国家心血管数据注册中心 ACTION 注册-GWTG 中纳入的 41560 例 STEMI 患者的数据。我们将该研究人群分为两组：初始 ECG 诊断为 STEMI 的患者（n=36994）和初始 ECG 无诊断意义但随后心电图诊断为 STEMI 的患者（n=4566）。
结果
一般而言，两组患者的基线特征和临床表现相似。对于初始 ECG 无诊断意义的患者，72.4%（n=3305）在初始 ECG 后 90 分钟内心电图诊断为 STEMI。两组患者接受 STEMI 指南推荐治疗、住院期间大出血（P=0.926）或死亡（P=0.475）的差异均无统计学意义。
结论
在全国 STEMI 患者样本中，有 11.0%的患者初始 ECG 无诊断意义。在这些患者中，72.4%在初始 ECG 后 90 分钟内进行了后续诊断性 ECG。在接受 STEMI 指南为基础的治疗和主要住院结局方面，与初始 ECG 诊断为 STEMI 的患者相比，初始 ECG 无诊断意义但随后心电图诊断为 STEMI 的患者之间似乎没有临床意义上的差异。
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