Bozbeyoğlu Emrah, Aslanger Emre, Yıldırımtürk Özlem, Şimşek Barış, Karabay Can Yücel, Şimşek Mustafa Aytek, Tekkeşin Ahmet İlker, Değertekin Muzaffer, Kozan Ömer
Division of Cardiology, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey.
Department of Cardiology, Yeditepe University Hospital, Istanbul, Turkey.
Ann Noninvasive Electrocardiol. 2018 Nov;23(6):e12568. doi: 10.1111/anec.12568. Epub 2018 Jun 25.
It may sometimes be difficult to differentiate subtle ST-segment elevation (STE) due to anterior myocardial infarction (MI) from benign variant (BV) STE. Recently, two related formulas were proposed for this purpose. However, they have never been tested in an external population.
Consecutive patients from May 2017 to January 2018, who were admitted with the diagnosis of acute anterior STEMI, were enrolled. Electrocardiograms were systematically reviewed and only subtle ones were included. First 200 consecutive patients with noncardiac chest pain were also enrolled as a control group. Relevant electrocardiographic parameters were measured.
A total of 379 anterior MI and 200 BV-STE cases were enrolled during study period. A total of 241 patients in STEMI group were excluded for not matching subtleness criteria, four patients in control group were also excluded because of prior left-anterior descending artery intervention. The three-variable formula, with recommended cut-point of 23.5, had a sensitivity, specificity, and diagnostic accuracy of 73.9%, 86.7%, and 81.4%, respectively. The four-variable formula, with the published cut-point of 18.2, had a sensitivity, specificity, and diagnostic accuracy of 83.3%, 87.7%, and 85.9%, respectively.
Three- and four-variable formulas with recommended cutoffs have a reasonable sensitivity, specificity, and diagnostic accuracy in differentiating subtle STEMI with BV-STE. Although both perform well, the four-variable formula has a higher sensitivity, specificity, and diagnostic accuracy and should be preferred.
有时很难将前壁心肌梗死（MI）所致的细微ST段抬高（STE）与良性变异（BV）STE区分开来。最近，为此提出了两个相关公式。然而，它们从未在外部人群中进行过测试。
纳入2017年5月至2018年1月连续收治的诊断为急性前壁ST段抬高型心肌梗死的患者。系统回顾心电图，仅纳入细微ST段抬高的患者。另外连续纳入200例非心源性胸痛患者作为对照组。测量相关心电图参数。
研究期间共纳入379例前壁心肌梗死和200例BV-STE病例。ST段抬高型心肌梗死组共有241例患者因不符合细微标准而被排除，对照组有4例患者因既往有左前降支介入治疗也被排除。三变量公式推荐切点为23.5，其敏感性、特异性和诊断准确性分别为73.9%、86.7%和81.4%。四变量公式已发表的切点为18.2，其敏感性、特异性和诊断准确性分别为83.3%、87.7%和85.9%。
具有推荐切点的三变量和四变量公式在区分细微ST段抬高型心肌梗死与BV-STE方面具有合理的敏感性、特异性和诊断准确性。虽然两者表现都不错，但四变量公式具有更高的敏感性、特异性和诊断准确性，应优先选用。
