Knowlman Thomas, Greenslade Jaimi H, Parsonage William, Hawkins Tracey, Ruane Lorcan, Martin Paul, Prasad Sandhir, Lancini Daniel, Cullen Louise
School of Medicine, University of Queensland, Brisbane, Queensland.
School of Public Health, Queensland University of Technology, Brisbane, Queensland.
Acad Emerg Med. 2017 Mar;24(3):344-352. doi: 10.1111/acem.13123.
The electrocardiograph (ECG) is an essential tool in initial management and risk stratification of patients with suspected acute coronary syndrome (ACS). A six-point reporting criterion has been proposed to facilitate standardized clinical assessment of patients presenting to the emergency department (ED) with suspected ACS. We set out to evaluate the efficacy of these criteria in identifying patients with major adverse cardiac events (MACE), Type 1 myocardial infarction (T1MI), Type 2 myocardial infarction (T2MI), and 1-year mortality in a cohort of emergency patients with chest pain.
This was an analysis of data from 2,349 patients who presented to the ED with chest pain between 2008 and 2013. Data were collected as part of two prospective trials. ECGs were recorded at presentation and categorized according to the six-point criteria by local cardiologists blinded to all clinical information. The primary outcome was 30-day MACE, including T1MI, T2MI, unstable angina pectoris, revascularization, and 30-day mortality. The outcome was adjudicated by cardiologists on the basis of all clinical information and test results. Likelihood ratios and odds ratios for 30-day MACE were reported for each ECG category.
Major adverse cardiac events were diagnosed in 264 (11.3%) patients. Increasing ischemic abnormalities in ECGs, as categorized by the standardized reporting criteria, were associated with increasing rates of MACE. Within 30 days, T1MI occurred in 148 (6.3%) patients and T2MI occurred in 59 (2.5%) patients. Risk for T1MI increased with higher classification of ECG abnormalities. T2MI rates were highest in patients with ECGs of nonspecific changes.
The rates of MACE, T1MI, and 1-year death can be stratified according to standardized ECG criteria in patients presenting to the ED with chest pain. The ECG findings in patients with T2MI are variable, and the ECG is less helpful in defining risk in this group.
心电图（ECG）是疑似急性冠状动脉综合征（ACS）患者初始管理和风险分层的重要工具。已提出一种六点报告标准，以促进对急诊科（ED）疑似ACS患者进行标准化临床评估。我们旨在评估这些标准在识别胸痛急诊患者发生主要不良心脏事件（MACE）、1型心肌梗死（T1MI）、2型心肌梗死（T2MI）和1年死亡率方面的有效性。
这是一项对2008年至2013年间因胸痛就诊于急诊科的2349例患者的数据进行的分析。数据作为两项前瞻性试验的一部分进行收集。就诊时记录心电图，并由对所有临床信息不知情的当地心脏病专家根据六点标准进行分类。主要结局是30天MACE，包括T1MI、T2MI、不稳定型心绞痛、血运重建和30天死亡率。结局由心脏病专家根据所有临床信息和检查结果进行判定。报告了每个心电图类别的30天MACE的似然比和比值比。
264例（11.3%）患者被诊断为主要不良心脏事件。根据标准化报告标准分类，心电图中缺血异常增加与MACE发生率增加相关。30天内，148例（6.3%）患者发生T1MI，59例（2.5%）患者发生T2MI。T1MI风险随心电图异常分类升高而增加。T2MI发生率在心电图有非特异性改变的患者中最高。
对于因胸痛就诊于急诊科的患者，可根据标准化心电图标准对MACE、T1MI和1年死亡率进行分层。T2MI患者的心电图表现各异，心电图在确定该组患者风险方面的帮助较小。
