Liang Hao, Wu Lan, Li Yingchen, Zeng Yidi, Hu Zhixi, Li Xinchun, Sun Xiang, Zhang Qiuyan, Zhou Xiaoqing
Institute of TCM Diagnostics Hunan Provincial Key Laboratory of TCM Diagnostics, Hunan University of Chinese Medicine The Third Xiangya Hospital, Central South University The Affiliated Hospital of Hunan Institute of Traditional Chinese Medicine, Hunan Institute of Traditional Chinese Medicine Cardiology Department, Hospital of Changsha, Changsha, Hunan, China.
Medicine (Baltimore). 2018 Jun;97(24):e10889. doi: 10.1097/MD.0000000000010889.
Prior studies have proposed several electrocardiogram (ECG) criteria in limb leads for identifying the culprit coronary artery (CCA) in patients with acute inferior wall myocardial infarction (IWMI). The aim of our study was to conduct an evidence-based evaluation and test accuracy comparison of these criteria.
We searched the PubMed, Embase, and Ovid. Eligible studies to assess the diagnostic performance of ECG criteria predicting CCA in IWMI were reviewed for inclusion. A diagnostic meta-analysis of bivariate approach was performed for pooled estimates of sensitivity and specificity, and meta-regression was implemented to investigate sources of heterogeneity.
Twenty-four studies with 4431 unique participants met the inclusion criteria. The pooled sensitivity and specificity for ST-segment elevation (STE) in III > II, ST-segment depression (STD) in I, STD in aVL, STD in aVL > I, STE in III > II, and STD in aVL > I were 0.91 (0.88-0.94) and 0.69 (0.53-0.81), 0.80 (0.73-0.87) and 0.69 (0.62-0.76), 0.90 (0.81-0.95) and 0.41 (0.22-0.62), 0.84 (0.75-0.91) and 0.72 (0.48-0.88), and 0.79 (0.62-0.90) and 1.00 (0.37-1.00), respectively. Heterogeneity investigation showed that whether multi-vessel diseased patients were excluded, sample size, publication year, etc., could influence the diagnostic performance.
STE in III > II performed better than other criteria for predicting RCA as CCA in IWMI, and STE in III > II and STD in aVL > I were potential and simple algorithms. ECG could be an effective tool to identify the CCA, but future studies are clearly needed to address the potential of diagnostic and prognostic value.
先前的研究提出了几种肢体导联心电图（ECG）标准，用于识别急性下壁心肌梗死（IWMI）患者的罪犯冠状动脉（CCA）。我们研究的目的是对这些标准进行循证评估并比较测试准确性。
我们检索了PubMed、Embase和Ovid。纳入了评估预测IWMI中CCA的ECG标准诊断性能的合格研究。采用双变量方法进行诊断性Meta分析，以汇总敏感性和特异性估计值，并进行Meta回归以研究异质性来源。
24项研究共4431名独立参与者符合纳入标准。III导联ST段抬高（STE）>II导联、I导联ST段压低（STD）、aVL导联STD、aVL导联STD>I导联、III导联STE>II导联以及aVL导联STD>I导联的汇总敏感性和特异性分别为0.91（0.88 - 0.94）和0.69（0.53 - 0.81）、0.80（0.73 - 0.87）和0.69（0.62 - 0.76）、0.90（0.81 - 0.95）和0.41（0.22 - 0.62）、0.84（0.75 - 0.91）和0.72（0.48 - 0.88），以及0.79（0.62 - 0.90）和1.00（0.37 - 1.00）。异质性研究表明，是否排除多支血管病变患者、样本量、发表年份等会影响诊断性能。
在预测IWMI中作为CCA的右冠状动脉（RCA）时，III导联STE>II导联的表现优于其他标准，且III导联STE>II导联和aVL导联STD>I导联是潜在且简单的算法。ECG可能是识别CCA的有效工具，但显然需要未来的研究来探讨其诊断和预后价值的潜力。
