Brush J E, Brand D A, Acampora D, Chalmer B, Wackers F J
N Engl J Med. 1985 May 2;312(18):1137-41. doi: 10.1056/NEJM198505023121801.
We evaluated the initial electrocardiogram as a predictor of complications in 469 patients with suspected acute myocardial infarction. An electrocardiogram was classified as positive if it showed one or more of the following: evidence of infarction, ischemia, or strain; left ventricular hypertrophy; left bundle-branch block; or paced rhythm. Forty-two (14 per cent) of 302 patients with positive electrocardiograms had at least one life-threatening complication (ventricular fibrillation, sustained ventricular tachycardia, or heart block), as compared with 1 (0.6 per cent) of 167 patients with a negative electrocardiogram. Life-threatening complications were therefore 23 times more likely if the initial electrocardiogram was positive (P less than 0.001). Other complications were 3 to 10 times more likely (P less than 0.01), interventions were 4 to 10 times more likely (P less than 0.05), and death was 17 times more likely (P less than 0.001) in patients with a positive electrocardiogram. We conclude that patients with a negative initial electrocardiogram have a low likelihood of complications and could be admitted to an intermediate care unit instead of a coronary care unit. This would reduce admissions to the coronary care unit by 36 per cent and thereby save considerable hospital costs without compromising patient care.
我们对469例疑似急性心肌梗死患者的初始心电图进行评估，以预测并发症。若心电图出现以下一项或多项表现，则分类为阳性：梗死、缺血或劳损迹象；左心室肥厚；左束支传导阻滞；或起搏心律。302例心电图阳性患者中有42例（14%）至少发生了一种危及生命的并发症（心室颤动、持续性室性心动过速或心脏传导阻滞），相比之下，167例心电图阴性患者中只有1例（0.6%）发生此类情况。因此，初始心电图呈阳性时，发生危及生命并发症的可能性要高23倍（P<0.001）。心电图阳性患者发生其他并发症的可能性高3至10倍（P<0.01），接受干预的可能性高4至10倍（P<0.05），死亡可能性高17倍（P<0.001）。我们得出结论，初始心电图阴性的患者发生并发症的可能性较低，可以入住中级护理病房而非冠心病监护病房。这将使冠心病监护病房的入院人数减少36%，从而在不影响患者护理的情况下节省可观的医院费用。
