Hiltner Emily, Al Akshar Ammar, Thanawala Prachi, Hakeem Abdul, Coromilas James, Kassotis John
Department of Medicine, Rutgers Robert Wood Johnson Medical School, United States.
Department of Medicine, Division of Cardiovascular Disease and Hypertension, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, United States.
J Electrocardiol. 2020 Sep-Oct;62:170-177. doi: 10.1016/j.jelectrocard.2020.08.022. Epub 2020 Sep 8.
The diagnostic accuracy of lead aVR ST-segment elevation for left main or triple vessel disease (LM/3VD) has not been universally accepted. In the present analysis we sought to evaluate the diagnostic accuracy of STEaVR in patients presenting with an acute coronary syndrome (ACS).
Pooled sensitivity, specificity, positive, and negative likelihood ratios were calculated using a random effects model (DerSimonian-Laird Method) for computing summary estimates and receiver operator curve (ROC) analysis for evaluating overall diagnostic accuracy.
This meta-analysis included 14 studies. The pooled sensitivity of STEaVR for LM/3VD was 0.40 (95% CI; 0.38 0.43, p < 0.001), specificity 0.82 (95% CI; 0.81-0.83, p < 0.001). Pooled positive likelihood ratio 2.49 (95% CI; 1.62-3.81, p < 0.001) and negative likelihood 0.54 (95% CI; 0.39-0.76, p < 0.001). The pooled sensitivity of STEaVR for LM was 0.39 (95% CI; 0.34-0.45, p < 0.001) specificity was 0.86 (95% CI; 0.85-0.87, p < 0.001) with an AUC of 0.79. The pooled positive likelihood ratio (LR) for LM was 2.78 (95% CI, 2.28-3.39, p < 0.001) negative likelihood ratio 0.51 (95% CI, 0.33-0.78, p < 0.001).
Our study shows that in patients presenting with an ACS, presence of STEaVR may indicate the presence of LM or 3VD. STEaVR has a high specificity for both LM and 3VD, with a high pooled LR.
aVR导联ST段抬高对左主干或三支血管病变（LM/3VD）的诊断准确性尚未得到普遍认可。在本分析中，我们试图评估急性冠状动脉综合征（ACS）患者中aVR导联ST段抬高（STEaVR）的诊断准确性。
使用随机效应模型（DerSimonian-Laird法）计算合并敏感性、特异性、阳性和阴性似然比，以计算汇总估计值，并采用受试者工作特征曲线（ROC）分析来评估总体诊断准确性。
该荟萃分析纳入了14项研究。STEaVR对LM/3VD的合并敏感性为0.40（95%CI：0.38 - 0.43，p < 0.001），特异性为0.82（95%CI：0.81 - 0.83，p < 0.001）。合并阳性似然比为2.49（95%CI：1.62 - 3.81，p < 0.001），阴性似然比为0.54（95%CI：0.39 - 0.76，p < 0.001）。STEaVR对LM的合并敏感性为0.39（95%CI：0.34 - 0.45，p < 0.001），特异性为0.86（95%CI：0.85 - 0.87，p < 0.001），曲线下面积（AUC）为0.79。LM的合并阳性似然比（LR）为2.78（95%CI，2.28 - 3.39，p < 0.001），阴性似然比为0.51（95%CI，0.33 - 0.78，p < 0.001）。
我们的研究表明，在ACS患者中，STEaVR的出现可能提示LM或3VD的存在。STEaVR对LM和3VD均具有较高的特异性，且合并似然比高。
