急性心肌梗死溶栓治疗后冠状动脉通畅情况的心电图预测：以ST段作为无创性标志物的应用
Electrocardiographic prediction of coronary artery patency after thrombolytic treatment in acute myocardial infarction: use of the ST segment as a non-invasive marker.
作者信息
Hogg K J, Hornung R S, Howie C A, Hockings N, Dunn F G, Hillis W S
机构信息
Department of Cardiology, University of Glasgow, Stobhill General Hospital.
出版信息
Br Heart J. 1988 Oct;60(4):275-80. doi: 10.1136/hrt.60.4.275.
The predictive value of the measurement of changes in ST segment elevation was assessed as a non-invasive marker of coronary artery reperfusion after thrombolytic treatment. Forty five patients with acute myocardial infarction (23 anterior, 22 inferior) of less than six hours' duration were given thrombolytic treatment by either the intravenous (n = 28) or the intracoronary route (n = 17). A proportional value for the shift in ST segment, termed the fractional change, was calculated both from 12 lead electrocardiograms and from the Holter tape for each patient. Coronary artery patency in an initial group of 22 patients (training group) was associated with a fractional change value of greater than or equal to 0.5 (100% specific, 88% sensitive by Holter analysis; 100% specific, 94% sensitive by 12 lead electrocardiogram). This rule performed well when it was applied to a test group of 17 patients (100% specific, 93% sensitive by Holter analysis; and 67% specific, 93% sensitive by 12 lead electrocardiogram). Linear discriminant analysis was then used to determine which features gave the best separation of those in whom there was reperfusion and those in whom there was not. This gave 100% specificity and 100% sensitivity when applied to the training group for either the 12 lead electrocardiogram or Holter monitoring. When it was applied to the test group, the sensitivity was maintained at 100%, but the specificity dropped to 33% irrespective of whether the basis of the test was Holter monitoring or the 12 lead electrocardiogram. These results suggest that a fractional change of >/= 0.5 calculated from a single lead showing myocardial injury is a useful non-invasive marker of reperfusion. The technique can be applied to either 12 lead electrocardiograms or Holter monitoring. The use of a more complex classification increased the sensitivity of the test at the expense of its specificity.
ST段抬高变化测量作为溶栓治疗后冠状动脉再灌注的无创性标志物，其预测价值得到了评估。45例急性心肌梗死患者（23例前壁，22例下壁），病程小于6小时，分别通过静脉途径（n = 28）或冠状动脉内途径（n = 17）接受溶栓治疗。计算每位患者12导联心电图和动态心电图记录的ST段移位的比例值，即分数变化。最初的22例患者（训练组）中，冠状动脉通畅与分数变化值大于或等于0.5相关（动态心电图分析特异性100%，敏感性88%；12导联心电图特异性100%，敏感性94%）。将该标准应用于17例患者的测试组时，效果良好（动态心电图分析特异性100%，敏感性93%；12导联心电图特异性67%，敏感性93%）。然后采用线性判别分析来确定哪些特征能最好地区分有再灌注和无再灌注的患者。将其应用于训练组的12导联心电图或动态心电图监测时，特异性和敏感性均为100%。应用于测试组时，无论测试依据是动态心电图监测还是12导联心电图，敏感性均维持在100%，但特异性降至33%。这些结果表明，从显示心肌损伤的单导联计算出的分数变化≥0.5是再灌注的有用无创性标志物。该技术可应用于12导联心电图或动态心电图监测。使用更复杂的分类方法会以牺牲特异性为代价提高测试的敏感性。
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