Division of Cardiology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wanglang Road, Bangkok Noi, Bangkok, 10700, Thailand.
Division of Cardiology, Department of Medicine, Nakhon Pathom Hospital, Nakhon Pathom, Thailand.
BMC Cardiovasc Disord. 2021 Dec 28;21(1):621. doi: 10.1186/s12872-021-02440-5.
Electrocardiography (ECG) is an essential investigation in patients with chronic coronary artery disease (CAD). However, evidence regarding the diagnostic and prognostic value of ECG in this population is limited. Therefore, we sought to determine whether baseline ECG abnormalities were associated with myocardial ischemia and cardiac events in patients with known or suspected chronic CAD.
Consecutive patients with known (n = 146) or suspected chronic CAD (n = 349) referred for adenosine stress cardiac magnetic resonance (CMR) between 2011 and 2014 were enrolled. Resting ECGs were classified as major, minor, and no abnormalities. Predictors of myocardial ischemia on CMR and major adverse cardiac events (MACE) including cardiac death, nonfatal myocardial infarction, hospitalization for heart failure and late revascularization (> 180 days after CMR) were evaluated.
Average age was 69 ± 11 years (51% men). One hundred and eighty-five patients (37.4%) had major and 154 (31.1%) had minor ECG abnormalities. In patients with suspected CAD, myocardial ischemia was presented in 83 patients (23.8%). Multivariable analysis demonstrated major ECG abnormality as the strongest predictor of myocardial ischemia (HR 2.51; 95% CI 1.44-4.36; p = 0.001). Adding ECG to clinical pretest probability models improved the prediction of myocardial ischemia in ROC analyses (p = 0.04). In the whole cohort (n = 495), 91 MACE occurred during the median follow-up period of 4.8 years. Multivariable analysis showed that diabetes mellites, history of heart failure, prior revascularization, left ventricular ejection fraction, ischemia, and major ECG abnormality were independent predictors of MACE.
Abnormal resting ECG is common in patients with known or suspected chronic CAD. ECG had important diagnostic and prognostic values in this population.
心电图（ECG）是慢性冠状动脉疾病（CAD）患者的基本检查。然而，关于该人群中 ECG 的诊断和预后价值的证据有限。因此，我们试图确定基线 ECG 异常是否与已知或疑似慢性 CAD 患者的心肌缺血和心脏事件相关。
连续纳入 2011 年至 2014 年间因腺苷应激心脏磁共振（CMR）而就诊的已知（n=146）或疑似慢性 CAD（n=349）患者。将静息 ECG 分为主要、次要和无异常。评估 CMR 上心肌缺血和主要不良心脏事件（MACE）的预测因素，包括心脏死亡、非致死性心肌梗死、心力衰竭住院和晚期血运重建（CMR 后>180 天）。
平均年龄为 69±11 岁（51%为男性）。185 例患者（37.4%）存在主要 ECG 异常，154 例（31.1%）存在次要 ECG 异常。在疑似 CAD 的患者中，83 例（23.8%）出现心肌缺血。多变量分析显示，主要 ECG 异常是心肌缺血的最强预测因素（HR 2.51；95%CI 1.44-4.36；p=0.001）。在 ROC 分析中，将 ECG 添加到临床预测试验概率模型可提高心肌缺血的预测能力（p=0.04）。在整个队列（n=495）中，在中位 4.8 年的随访期间发生了 91 例 MACE。多变量分析显示，糖尿病、心力衰竭史、先前血运重建、左心室射血分数、缺血和主要 ECG 异常是 MACE 的独立预测因素。
在已知或疑似慢性 CAD 患者中，静息 ECG 异常很常见。ECG 在该人群中具有重要的诊断和预后价值。
