Mixon Timothy A, Hardegree Evan, Shah Jinesh, Grable Margarite, Fikes Wanda
Division of Cardiology, Department of Internal Medicine, Baylor Scott & White HealthTempleTexas.
Proc (Bayl Univ Med Cent). 2019 May 14;32(3):331-335. doi: 10.1080/08998280.2019.1596442. eCollection 2019 Jul.
ST-elevation myocardial infarction (STEMI) is a clinical diagnosis based on a compatible history and characteristic electrocardiographic changes. In the current era, STEMI is treated emergently with angiography, leading to percutaneous coronary intervention. However, false-positive electrocardiograms (ECGs) occur, resulting in unnecessary emergent catheterizations. We hypothesized that the Vectraplex cardiac electrical biomarker (CEB) would increase the specificity for the diagnosis of STEMI. We studied 50 patients who were identified by standard of care (clinical history, physical exam, and 12-lead ECG) as suspected to have STEMI and tested the sensitivity and specificity of the Vectraplex ECG system. Using the final clinical diagnosis (based on history, ECGs, troponin values, and angiographic findings) as the gold standard, we found the CEB value to be quite dynamic, with a reasonable sensitivity and a good positive predictive value but generally poor specificity and negative predictive value. It offered only a 20% improvement compared to 50-50 performance on receiver operator curves.
ST段抬高型心肌梗死（STEMI）是一种基于相符病史和特征性心电图变化的临床诊断。在当今时代，STEMI通过血管造影进行紧急治疗，进而实施经皮冠状动脉介入治疗。然而，会出现心电图（ECG）假阳性情况，导致不必要的紧急导管插入术。我们推测Vectraplex心脏电学生物标志物（CEB）会提高STEMI诊断的特异性。我们研究了50例根据护理标准（临床病史、体格检查和12导联心电图）被判定疑似患有STEMI的患者，并测试了Vectraplex心电图系统的敏感性和特异性。以最终临床诊断（基于病史、心电图、肌钙蛋白值和血管造影结果）作为金标准，我们发现CEB值变化很大，具有合理的敏感性和良好的阳性预测值，但总体特异性和阴性预测值较差。与在受试者工作特征曲线上50%的表现相比，其仅提高了20%。
