Division of Cardiology, Yokohama City University Medical Center.
Department of Cardiovascular Medicine, Kumamoto University Hospital.
Circ J. 2024 Oct 25;88(11):1800-1808. doi: 10.1253/circj.CJ-24-0485. Epub 2024 Sep 20.
The importance of prehospital (PH) electrocardiograms (ECG) recorded by emergency medical services (EMS) for diagnosing coronary artery spasm-induced acute coronary syndrome (CS-ACS) remains unclear.
We enrolled 340 consecutive patients with ACS who were transported by EMS within 12 h of symptom onset. According to Japanese Circulation Society guidelines, CS-ACS (n=48) was diagnosed with or without a pharmacological provocation test (n=34 and n=14, respectively). Obstructive coronary artery-induced ACS (OC-ACS; n=292) was defined as ACS with a culprit lesion showing 99% stenosis or >75% stenosis with plaque rupture or thrombosis observed via angiographic and intravascular imaging. Ischemic ECG findings included ST-segment deviation (elevation or depression) and negative T and U waves. In CS-ACS, the prevalence of ST-segment deviation decreased significantly from PH-ECG to emergency room (ER) ECG (77.0% vs. 35.4%; P<0.001), as did the prevalence of overall ECG abnormalities (81.2% vs. 45.8%; P<0.001). Conversely, in OC-ACS, there was a similar prevalence on PH-ECG and ER-ECG of ST-segment deviations (94.8% vs. 92.8%, respectively; P=0.057) and abnormal ECG findings (96.9% vs. 95.2%, respectively; P=0.058). Patients with abnormal PH-ECG findings that disappeared upon arrival at hospital without ER-ECG or troponin abnormalities were more frequent in the CS-ACS than OC-ACS group (20.8% vs. 1.0%; P<0.001).
PH-ECG is valuable for detecting abnormal ECG findings that disappear upon arrival at hospital in CS-ACS patients.
院前（PH）心电图（ECG）记录对诊断由冠状动脉痉挛引起的急性冠状动脉综合征（CS-ACS）的重要性尚不清楚。
我们纳入了 340 例在症状发作后 12 小时内由急救医疗服务（EMS）转运的 ACS 连续患者。根据日本循环协会指南，CS-ACS（n=48）的诊断标准为（n=34 和 n=14），或无药物激发试验。阻塞性冠状动脉诱导的 ACS（OC-ACS；n=292）的定义为 ACS 伴罪犯病变显示 99%狭窄或 >75%狭窄，斑块破裂或血栓形成通过血管造影和血管内成像观察。缺血性心电图发现包括 ST 段偏移（抬高或压低）和负 T 和 U 波。在 CS-ACS 中，PH-ECG 到急诊室（ER）ECG 的 ST 段偏移发生率显著降低（77.0% vs. 35.4%；P<0.001），整体心电图异常发生率也显著降低（81.2% vs. 45.8%；P<0.001）。相反，在 OC-ACS 中，PH-ECG 和 ER-ECG 的 ST 段偏移发生率相似（94.8% vs. 92.8%，分别；P=0.057）和异常心电图发现（96.9% vs. 95.2%，分别；P=0.058）。在没有 ER-ECG 或肌钙蛋白异常的情况下，入院时异常 PH-ECG 发现消失的患者在 CS-ACS 组比 OC-ACS 组更常见（20.8% vs. 1.0%；P<0.001）。
PH-ECG 对检测 CS-ACS 患者入院时消失的异常心电图发现具有重要价值。
