Department of Clinical Physiology, Växjö Central Hospital, Växjö, Sweden.
Department of Research and Development, Region Kronoberg, Sweden.
Scand Cardiovasc J. 2020 Apr;54(2):100-107. doi: 10.1080/14017431.2019.1705383. Epub 2019 Dec 30.
Pericarditis, takotsubo cardiomyopathy and early repolarization syndrome (ERS) are well-known to mimic ST elevation myocardial infarction (STEMI). We aimed to study whether ECG findings of reciprocal ST depression, PR depression, ST-segment convexity or terminal QRS distortion can discriminate between ST elevation due to ischemia and non-ischemic conditions. Eighty-five patients with STEMI and 94 patients with non-ischemic ST elevation were included. All patients had acute chest pain and at least 0.1 mV ST elevation. Presence of PR depression, ST-segment convexity, terminal QRS distortion or reciprocal ST depression was assessed in each ECG. In anterior ST elevation, ST depression in lead II (≥0.025 mV) occurred in 40% of patients with STEMI but in none of the non-ischemic cases. In inferior ST elevation, ST depression in lead I (≥0.025 mV) was present in 83% of patients with STEMI but in none of the non-ischemic cases. Chest-lead PR depression was uncommon in STEMI (12%) compared to non-ischemic cases (38%; < .001). Convex ST elevation occurred in 22% of STEMI cases and in 9% of non-ischemic cases ( = .01). Terminal QRS distortion was more prevalent in STEMI (40%) than in non-ischemic ST elevation (7%). In multivariable analysis, reciprocal ST depression was associated with an ischemic diagnosis, whereas ST depression in aVR and chest-lead PR depression were associated with a non-ischemic diagnosis. Identification of true STEMI among patients with different ST-elevation etiology may be improved by considering reciprocal ST depression, ST depression in aVR and chest-lead PR depression.
心包炎、心尖球形综合征和早期复极综合征（ERS）众所周知可模拟 ST 段抬高型心肌梗死（STEMI）。我们旨在研究 ST 段抬高是否由缺血和非缺血条件引起，是否可以通过心电图的镜像性 ST 段压低、PR 段压低、ST 段凸面或终末 QRS 扭曲来区分。共纳入 85 例 STEMI 患者和 94 例非缺血性 ST 段抬高患者。所有患者均有急性胸痛和至少 0.1mV 的 ST 段抬高。评估每个心电图中的 PR 段压低、ST 段凸面、终末 QRS 扭曲或镜像性 ST 段压低。在前壁 ST 段抬高中，STEMI 患者中有 40%出现 II 导联 ST 段压低（≥0.025mV），而非缺血性患者无一例出现。在下壁 ST 段抬高中，STEMI 患者中有 83%出现 I 导联 ST 段压低（≥0.025mV），而非缺血性患者无一例出现。STEMI 患者中少见 chest-lead PR 段压低（12%），而非缺血性患者中则较为常见（38%； < .001）。凸面 ST 段抬高在 STEMI 患者中发生率为 22%，而非缺血性患者中发生率为 9%（ = .01）。终末 QRS 扭曲在 STEMI 患者中更为常见（40%），而非缺血性 ST 段抬高患者中则少见（7%）。多变量分析显示，镜像性 ST 段压低与缺血性诊断相关，而 aVR 导联 ST 段压低和 chest-lead PR 段压低与非缺血性诊断相关。通过考虑镜像性 ST 段压低、aVR 导联 ST 段压低和 chest-lead PR 段压低，可能会提高对不同 ST 段抬高病因患者中真正 STEMI 的识别。
