Costin Nathaniel I, Korach Amit, Loor Gabriel, Peterson Mark D, Desai Nimesh D, Trimarchi Santi, de Vincentiis Carlo, Ota Takeyoshi, Reece T Brett, Sundt Thoralf M, Patel Himanshu J, Chen Edward P, Montgomery Dan G, Nienaber Christoph A, Isselbacher Eric M, Eagle Kim A, Gleason Thomas G
Cardiovascular Center, University of Michigan, Ann Arbor, Michigan.
Department of Cardiothoracic Surgery, Hadassah Hebrew University Medical Center, Jerusalem, Israel.
Ann Thorac Surg. 2018 Jan;105(1):92-99. doi: 10.1016/j.athoracsur.2017.06.063. Epub 2017 Nov 1.
The electrocardiogram (ECG) is often used in the diagnosis of patients presenting with chest pain to emergency departments. Because chest pain is a common manifestation of type A acute aortic dissection (TAAAD), ECGs are obtained in much of this population. We evaluated the effect of particular ECG patterns on the diagnosis and treatment of TAAAD.
TAAAD patients (N = 2,765) enrolled in the International Registry of Acute Aortic Dissection were stratified based on normal (n = 1,094 [39.6%]) and abnormal (n = 1,671 [60.4%]) findings on presenting ECGs and further subdivided according to specific ECG findings. Time data are presented in hours as medians (quartile 1 to quartile 3).
Patients with ECGs with abnormal findings presented to the hospital sooner after symptom onset than those with ECGs with normal findings (1.4 [0.8 to 3.3] vs 2.0 [1.0 to 3.3]; p = 0.005). Specifically, this was seen in patients with infarction with new Q waves or ST elevation (1.3 [0.6 to 2.7] vs 1.5 [0.8 to 3.3]; p = 0.049). Interestingly, the time between symptom onset and diagnosis was longer with infarction with old Q waves (6.7 [3.2 to 18.4] vs 5.0 [2.9 to 11.8]; p = 0.034) and nonspecific ST-T changes (5.8 [3.0 to 13.8] vs 4.5 [2.8 to 10.5]; p = 0.002). Surgical mortality was higher in patients with abnormal ECG findings (20.6% vs 11.9%, p < 0.001), especially in those with ischemia by ECG (25.7% vs 16.8%, p < 0.001) and infarction with new Q waves or ST elevation (30.1% vs 17.1%, p < 0.001).
TAAAD patients presenting with abnormal ECG results are sicker, have more in-hospital complications, and are more likely to die. The frequency of nonspecific ST-T abnormalities and its association with delay in diagnosis and treatment presents an opportunity for practice improvement.
心电图（ECG）常用于急诊科对胸痛患者的诊断。由于胸痛是A型急性主动脉夹层（TAAAD）的常见表现，因此该人群中的许多患者都进行了心电图检查。我们评估了特定心电图模式对TAAAD诊断和治疗的影响。
纳入国际急性主动脉夹层注册研究的TAAAD患者（N = 2765）根据就诊时心电图正常（n = 1094 [39.6%]）和异常（n = 1671 [60.4%]）结果进行分层，并根据具体心电图结果进一步细分。时间数据以小时为单位表示为中位数（四分位数1至四分位数3）。
心电图异常的患者在症状出现后比心电图正常的患者更早入院（1.4 [0.8至3.3] 对2.0 [1.0至3.3]；p = 0.005）。具体而言，新发Q波或ST段抬高的梗死患者中可见这种情况（1.3 [0.6至2.7] 对1.5 [0.8至3.3]；p = 0.049）。有趣的是，陈旧性Q波梗死（6.7 [3.2至18.4] 对5.0 [2.9至11.8]；p = 0.034）和非特异性ST-T改变（5.8 [3.0至13.8] 对4.5 [2.8至10.5]；p = 0.002）患者从症状出现到诊断的时间更长。心电图异常的患者手术死亡率更高（20.6% 对11.9%，p < 0.001），尤其是心电图显示缺血的患者（25.7% 对16.8%，p < 0.001）以及新发Q波或ST段抬高的梗死患者（30.1% 对17.1%，p < 0.001）。
心电图结果异常的TAAAD患者病情更重，住院并发症更多，死亡可能性更大。非特异性ST-T异常的频率及其与诊断和治疗延迟的关联为实践改进提供了机会。
