Gifft Kristina, Ghadban Rugheed, Assefa Nina, Luebbering Zachary, Allaham Haytham, Enezate Tariq
Department of General Medicine, University of Missouri Health Care, Columbia, MO, USA.
Division of Cardiology, Washington University, St Louis, MO, USA.
Arch Med Sci Atheroscler Dis. 2020 Sep 10;5:e226-e229. doi: 10.5114/amsad.2020.98924. eCollection 2020.
ST-segment elevation distribution on electrocardiogram (ECG) in patients presenting with ST-elevation myocardial infarction (STEMI) accurately localises the culprit vessel. However, the utility of the ECG changes in localising the coronary culprit territory in the setting of non-ST segment elevation myocardial infarction (NSTEMI) is not well established.
This study included patients presenting with NSTEMI, who had dynamic non-ST elevation ischaemic changes in one or more ECG leads and underwent percutaneous coronary intervention (PCI) in a single vessel between October 2011 and November 2017 in a single university hospital institution. The accuracy, sensitivity, and specificity of the distribution of ECG changes in localising the culprit vessel were calculated.
There was a total of 82 patients included in this study, who received PCI to the left anterior descending (LAD), right coronary artery (RCA), and left circumflex (LCX), in 43.9%, 24.4%, and 31.7%, respectively; 51% were male. In this cohort, sensitivity of ECG in localising single-culprit-vessel NSTEMI was 41.5%. The overall accuracy of ECG changes was 50.0%, 72.0%, and 70.0% in LAD, RCA, and LCX distribution, respectively. The sensitivity and specificity were 72.2% and 32.6% in LAD distribution, 20% and 88.7% in RCA distribution, and 15.4% and 82.1% in LCX distributions, respectively.
Ischaemic non-ST elevation ECG changes had modest accuracy in localising the culprit vessel in patients with PCI-treated NSTEMI. These changes were more sensitive in LAD distribution and more specific in RCA and LCX distributions.
ST段抬高型心肌梗死（STEMI）患者心电图（ECG）上ST段抬高的分布能准确地定位罪犯血管。然而，在非ST段抬高型心肌梗死（NSTEMI）情况下，ECG改变在定位冠状动脉罪犯区域方面的效用尚未明确确立。
本研究纳入了出现NSTEMI的患者，这些患者在一个或多个ECG导联有动态非ST段抬高缺血性改变，并于2011年10月至2017年11月在一家大学医院机构接受了单支血管的经皮冠状动脉介入治疗（PCI）。计算了ECG改变分布在定位罪犯血管方面的准确性、敏感性和特异性。
本研究共纳入82例患者，分别对左前降支（LAD）、右冠状动脉（RCA）和左旋支（LCX）进行了PCI，比例分别为43.9%、24.4%和31.7%；51%为男性。在该队列中，ECG定位单罪犯血管NSTEMI的敏感性为41.5%。ECG改变在LAD、RCA和LCX分布中的总体准确性分别为50.0%、72.0%和70.0%。LAD分布中的敏感性和特异性分别为72.2%和32.6%，RCA分布中分别为20%和88.7%，LCX分布中分别为15.4%和82.1%。
缺血性非ST段抬高ECG改变在定位接受PCI治疗的NSTEMI患者的罪犯血管方面准确性一般。这些改变在LAD分布中更敏感，在RCA和LCX分布中更具特异性。
