Millard Michael A, Nagarajan Vijaiganesh, Kohan Luke C, Schutt Robert C, Keeley Ellen C
Department of Medicine, Division of Cardiology, University of Virginia, Charlottesville, VA, USA.
Houston Methodist DeBakey Heart & Vascular Center, Houston, TX, USA.
Ann Noninvasive Electrocardiol. 2017 Jul;22(4). doi: 10.1111/anec.12429. Epub 2017 Jan 3.
A proportion of patients with ST elevation myocardial infarction (STEMI) have an initial electrocardiogram (ECG) that is nondiagnostic and are definitively diagnosed on a subsequent ECG. Our aim was to assess whether patients with a nondiagnostic initial ECG are different than those with a diagnostic initial ECG.
We collected demographic, ECG, medication, angiographic, and in-hospital clinical outcome data in consecutive patients undergoing primary percutaneous coronary intervention for STEMI at our institution from June 2009 to June 2013.
A total of 334 patients were included, 285 (85%) diagnosed on the initial ECG and 49 (15%) on a subsequent ECG. Patients with a nondiagnostic initial ECG had more comorbidities including prior congestive heart failure (14% vs. 3%, p < .001), coronary artery disease (47% vs. 24%, p = .001), diabetes (37% vs. 16%, p = .001), and hyperlipidemia (55% vs. 40%, p = .048); higher rates of chronic medication use including aspirin (47% vs. 27%, p = .005), beta-blocker (47% vs. 22%, p < .001), and statins (53% vs. 28%, p = .001); longer door-to-balloon times (106 min vs. 45 min, p < .001); lower peak troponin levels (25 ng/ml vs. 50 ng/ml, p = .004), longer diagnostic ECG to balloon times (84 min vs. 75 min, p = .006); and higher rates of a patent infarct-related artery on baseline angiography (41% vs. 24%, p = .018) which remained significant in a multivariable logistic regression model.
Approximately one in seven STEMI patients had an initial ECG that was nondiagnostic for STEMI. These patients had more comorbidities, higher rates of medication use, and received delayed intervention (even after the diagnosis was definitive).
一部分ST段抬高型心肌梗死（STEMI）患者的初始心电图（ECG）无法确诊，需后续心电图才能明确诊断。我们的目的是评估初始心电图无法确诊的患者与初始心电图可确诊的患者是否存在差异。
我们收集了2009年6月至2013年6月在我院接受STEMI直接经皮冠状动脉介入治疗的连续患者的人口统计学、心电图、用药、血管造影及院内临床结局数据。
共纳入334例患者，其中285例（85%）初始心电图确诊，49例（15%）后续心电图确诊。初始心电图无法确诊的患者合并症更多，包括既往充血性心力衰竭（14%对3%，p <.001）、冠状动脉疾病（47%对24%，p =.001）、糖尿病（37%对16%，p =.001）和高脂血症（55%对40%，p =.048）；长期用药率更高，包括阿司匹林（47%对27%，p =.005）、β受体阻滞剂（47%对22%，p <.001）和他汀类药物（53%对28%，p =.001）；门球时间更长（106分钟对45分钟，p <.001）；肌钙蛋白峰值水平更低（25 ng/ml对50 ng/ml，p =.004），诊断性心电图至球囊时间更长（84分钟对75分钟，p =.006）；基线血管造影时梗死相关动脉通畅率更高（41%对24%，p =.018），在多变量逻辑回归模型中仍具有显著性。
约七分之一的STEMI患者初始心电图无法确诊STEMI。这些患者合并症更多，用药率更高，且接受延迟干预（即使确诊后）。
