Duyan Murat, Ibze Süleyman, Vural Nafis, Guven Hasan Can, Ertas Elif, Avci Rauf, Gunlu Serhat, Cete Yıldıray
Department of Emergency Medicine, Antalya Training and Research Hospital, Varlik District, Kazim Karabekir Street, 07100, Antalya, Turkey.
Faculty of Medicine, Emergency Medicine Specialist, Department of Emergency Medicine, Akdeniz University, Antalya, Turkey.
Intern Emerg Med. 2025 Jan 4. doi: 10.1007/s11739-024-03855-6.
Patients presenting with suspected acute coronary syndrome (ACS) in the emergency department (ED) require rapid and accurate electrocardiographic (ECG) evaluation. This study aims to assess conventional ECG markers for diagnosing non-ST-elevation ACS (NSTE-ACS) in patients with chest discomfort and right bundle branch block (RBBB). A nested case-control design was employed to compare patients with RBBB admitted to the ED for suspected cardiac ischemia, focusing on those who developed NSTE-ACS versus those who did not. The sample consisted of 352 patients with suspected ACS and RBBB identified on ECG. Among them, 88 were diagnosed with NSTE-ACS. In the presence of RBBB, ST-segment elevation on the isoelectric line and/or positive T-waves on the ECG were significantly associated with the diagnosis of NSTE-ACS (p < 0.05). In patients who developed NSTE-ACS, the likelihood of an isoelectric ST-segment was 3.48 (95% CI 2.07-5.82) times higher, the likelihood of positive T-waves was 4.16 (95% CI 2.51-6.91) times higher, and the combination of an isoelectric ST-segment with positive T-waves was 4.81 (95% CI 2.28-8.25) times higher (p < 0.05). In addition, ST-segment depression and non-negative T-waves were significantly more frequent in patients who developed NSTE-ACS, with odds ratios of 5.78 (95% CI 3-11.3), compared to those who did not (p < 0.05). The odds ratios for ST-segment and T-wave changes were 2.81 and 3.47, respectively, with an 80% correct classification rate for predicting NSTE-ACS. Clinicians should closely monitor the presence of an isoelectric ST-segment and positive T-waves in patients with RBBB to assess for potential cardiac ischemia.
在急诊科（ED）就诊的疑似急性冠状动脉综合征（ACS）患者需要进行快速准确的心电图（ECG）评估。本研究旨在评估用于诊断有胸痛和右束支传导阻滞（RBBB）患者的非ST段抬高型ACS（NSTE-ACS）的传统ECG指标。采用巢式病例对照设计，比较因疑似心脏缺血而入住ED的RBBB患者，重点关注发生NSTE-ACS的患者与未发生者。样本包括352例ECG显示疑似ACS和RBBB的患者。其中，88例被诊断为NSTE-ACS。在存在RBBB的情况下，ECG上基线等电位线的ST段抬高和/或正向T波与NSTE-ACS的诊断显著相关（p<0.05）。发生NSTE-ACS的患者中，等电位ST段出现的可能性高3.48倍（95%CI 2.07-5.82），正向T波出现的可能性高4.16倍（95%CI 2.51-6.91），等电位ST段与正向T波同时出现的可能性高4.81倍（95%CI 2.28-8.25）（p<0.05）。此外，发生NSTE-ACS的患者中ST段压低和非负向T波明显更常见，与未发生者相比，比值比为5.78（95%CI 3-11.3）（p<0.05）。ST段和T波改变的比值比分别为2.81和3.47，预测NSTE-ACS的正确分类率为80%。临床医生应密切监测RBBB患者等电位ST段和正向T波的出现情况，以评估潜在的心脏缺血。
