Lindow T, Wiiala J, Lundager Forberg J, Lassen A T, Brabrand M, Platonov P G, Ekelund U
Department of Clinical Physiology, Department of Research and Development, Växjö Central Hospital, Sweden; Clinical Physiology, Clinical Sciences, Lund University, Sweden.
Emergency Medicine, Clinical Sciences, Skåne University Hospital, Lund University, Sweden.
J Electrocardiol. 2020 Jan-Feb;58:165-170. doi: 10.1016/j.jelectrocard.2019.12.012. Epub 2019 Dec 16.
In the ECG, significant ST elevation or depression according to specific amplitude criteria can be indicative of acute coronary syndrome (ACS). Guidelines state that the ST amplitude should be measured at the J point, but data to support that this is the optimal measuring point for ACS detection is lacking. We evaluated the impact of different measuring points for ST deviation on the diagnostic accuracy for ACS in unselected emergency department (ED) chest pain patients.
We included 14,148 adult patients with acute chest pain and an ECG recorded at a Swedish ED between 2010 and 2014. ST deviation was measured at the J point (STJ) and at 20, 40, 60 and 80 ms after the J point. A discharge diagnosis of ACS or not at the index visit was noted in all patients.
In total, 1489 (10.5%) patients had ACS. ST amplitude criteria at STJ had a sensitivity of 28% and a specificity of 92% for ACS. With these criteria, the highest positive and negative predictive values for ACS were obtained near the J point, but the optimal point varied with ST deviation, age group and sex. The overall best measuring points were STJ and ST20.
This study indicates that the diagnostic accuracy of the ECG criteria for ACS is very low in ED chest pain patients, and that the optimal measuring point for the ST amplitude in the detection of ACS differs between ST elevation and depression, and between patient subgroups.
在心电图中，根据特定幅度标准出现的显著ST段抬高或压低可能提示急性冠状动脉综合征（ACS）。指南指出，ST段幅度应在J点测量，但缺乏支持这是检测ACS最佳测量点的数据。我们评估了不同测量点的ST段偏移对未选择的急诊科（ED）胸痛患者ACS诊断准确性的影响。
我们纳入了2010年至2014年间在瑞典一家急诊科就诊的14148例有急性胸痛且记录了心电图的成年患者。在J点（STJ）以及J点后20、40、60和80毫秒处测量ST段偏移。记录所有患者在首次就诊时是否诊断为ACS。
共有1489例（10.5%）患者患有ACS。STJ处的ST段幅度标准对ACS的敏感性为28%，特异性为92%。采用这些标准，ACS的最高阳性和阴性预测值在J点附近获得，但最佳点随ST段偏移、年龄组和性别而变化。总体最佳测量点为STJ和ST20。
本研究表明，在急诊科胸痛患者中，心电图诊断ACS标准的准确性非常低，并且在检测ACS时，ST段幅度的最佳测量点在ST段抬高和压低之间以及患者亚组之间存在差异。
