Shaikh Muhammed Kashif, Ali Shah Syed Zulfiquar, Kumar Chandar, Lohano Munisha, Talpur Abdul Subhan, Zahoor Anika, Kumar Vijay, Kumar Besham
Interventional Cardiology, Liaquat University of Medical and Health Sciences, Jamshoro, PAK.
Medicine, Liaquat University of Medical and Health Sciences, Jamshoro, PAK.
Cureus. 2021 Apr 13;13(4):e14448. doi: 10.7759/cureus.14448.
There is very limited data comparing the accuracy of ECG to angiography in predicting reperfusion status. In this study, we will determine the accuracy of ECG change i.e. resolution of ST-segment elevation in predicting infarct-related artery (IRA) patency after thrombolysis in patients with ST-segment elevated myocardial infarction (STEMI), in comparison to angiography.
Three hundred and forty-one (n = 341) patients with acute STEMI received streptokinase, a thrombolytic agent within 12 hours of symptoms, and were enrolled in the study via consecutive convenient non-probability sampling. ECG was recorded as soon as the patient arrived in the emergency unit of cardiology. Subsequent ECG was recorded three hours after the administration of streptokinase to look for resolution of ST-segment elevation. ST-segment resolution was classified as greater/equal to 50% resolved or less than 50% resolved. Coronary angiography was performed within 24 hours of hospitalization and flow in the IRA was assessed.
The most common site of myocardial infarction (MI) was the anterior wall (50.1%) and the commonest artery involved was the left anterior descending artery (44.2%). On ECG, ST-resolution of more than 50% was found in 242 (70.9%) participants. Thrombolysis in MI (TIMI) grade III flow in angiography was found in 211 (61.8%) participants. The sensitivity and specificity of ST-resolution to detect TIMI grade III flow was 94.79% and 67.69%, respectively, while accuracy was 84.46%.
ST-resolution on ECG after streptokinase can predict IRA patency on coronary angiography with moderate to good accuracy. ECG can assist in predicting the impact of streptokinase early in the course of management and give an option of monitoring patient prognosis with a non-invasive test in patients not comfortable with angiography.
在预测再灌注状态方面，比较心电图与血管造影术准确性的数据非常有限。在本研究中，我们将确定心电图变化（即ST段抬高的消退）在预测ST段抬高型心肌梗死（STEMI）患者溶栓后梗死相关动脉（IRA）通畅情况时的准确性，并与血管造影术进行比较。
341例急性STEMI患者在症状出现后12小时内接受了溶栓药物链激酶治疗，并通过连续便利的非概率抽样纳入研究。患者一到达心脏病学急诊室就记录心电图。在给予链激酶3小时后记录后续心电图，以观察ST段抬高的消退情况。ST段消退分为消退大于或等于50%或小于50%。在住院24小时内进行冠状动脉造影，并评估IRA中的血流情况。
心肌梗死（MI）最常见的部位是前壁（50.1%），最常受累的动脉是左前降支动脉（44.2%）。在心电图上，242名（70.9%）参与者的ST段消退超过50%。血管造影显示心肌梗死溶栓（TIMI）III级血流的有211名（61.8%）参与者。ST段消退检测TIMI III级血流的敏感性和特异性分别为94.79%和67.69%，而准确性为84.46%。
链激酶治疗后心电图上的ST段消退能够以中等到良好的准确性预测冠状动脉造影时IRA的通畅情况。心电图有助于在治疗过程早期预测链激酶的疗效，并为那些不适合进行血管造影的患者提供一种通过无创检查监测患者预后的选择。
