Department of Cardiology, Yeditepe University Hospital, Istanbul, Turkey.
Division of Cardiology, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey.
Am J Cardiol. 2018 Oct 15;122(8):1303-1309. doi: 10.1016/j.amjcard.2018.06.053. Epub 2018 Jul 19.
Benign variant (BV) ST-segment elevation (STE) is present in anterior chest leads in most individuals and may cause diagnostic confusion in patients presenting with chest pain. Recently, 2 regression formulas were proposed for differentiation of BV-STE from anterior ST-elevation myocardial infarction (MI) on the electrocardiogram, computation of which is heavily device-dependent. We hypothesized that a simpler visual-assessment-based formula, namely (R-wave amplitude in lead V4 + QRS amplitude in V2) - (QT interval in millimeters + STE60 in V3), will be noninferior to these formulas. Consecutive cases of proven left anterior descending occlusion were reviewed, and those with obvious ST elevation MI were excluded. First 200 consecutive patients with noncardiac chest pain and BV-STE were also enrolled as a control group. Relevant electrocardiographic parameters were measured. There were 138 anterior MI and 196 BV-STE cases. Our simple formula was superior to the 3- and noninferior to the 4-variable formulas. This new practical formula had an excellent area-under curve of 0.963 (95% confidence interval, 0.946 to 0.980, p<0.001). It also had a sensitivity, specificity and diagnostic accuracy of 86.9%, 92.3%, and 90.1%, respectively. In conclusion, a simple visual assessment-based formula can reliably differentiate STE MI from BV-STE. Also, our results emphasize that focusing only on STE for diagnosing acute coronary occlusion is extremely insensitive and even puts the term "STEMI" itself into question.
良性变异型 (BV) ST 段抬高 (STE) 在大多数人前胸导联中存在，可能导致胸痛患者的诊断混淆。最近，提出了 2 种回归公式来区分心电图上的 BV-STE 与前壁 ST 段抬高型心肌梗死 (MI)，计算这些公式严重依赖设备。我们假设一种更简单的基于视觉评估的公式，即 (V4 导联 R 波振幅 + V2 导联 QRS 振幅) - (毫米 QT 间期 + V3 导联 STE60)，将不劣于这些公式。回顾了已证实的左前降支闭塞的连续病例，并排除了明显 ST 抬高 MI 的病例。还纳入了 200 例连续的非心源性胸痛且存在 BV-STE 的患者作为对照组。测量了相关心电图参数。共有 138 例前壁 MI 和 196 例 BV-STE 病例。我们的简单公式优于 3 变量公式，且非劣于 4 变量公式。这个新的实用公式的曲线下面积为 0.963（95%置信区间，0.946 至 0.980，p<0.001）。它的灵敏度、特异性和诊断准确性分别为 86.9%、92.3%和 90.1%。总之，一种简单的基于视觉评估的公式可以可靠地区分 STE MI 与 BV-STE。此外，我们的结果强调，仅关注 STE 来诊断急性冠状动脉闭塞的方法极其不敏感，甚至使“STEMI”一词本身受到质疑。
