Morris D D, Rozanski A, Berman D S, Diamond G A, Swan H J
Circulation. 1984 Aug;70(2):192-201. doi: 10.1161/01.cir.70.2.192.
To assess alternative criteria for the prediction of multivessel coronary artery disease after myocardial infarction, we compared the clinical, bicycle electrocardiographic, and radionuclide ventriculographic (ejection fraction and wall motion) responses in 110 patients undergoing coronary angiography after myocardial infarction. Ninety-seven of the 110 patients had multivessel coronary artery disease (two or more diseased vessels). Clinical or electrocardiographic abnormalities were observed in 41 of 97 (sensitivity = 43%) patients with multivessel disease, and in only two of 13 (specificity = 85%) patients without multivessel disease. The average information content of these combined clinical and electrocardiographic variables relative to perfect discrimination was 5%. Among the scintigraphic parameters, the conventional criterion for ejection fraction abnormality, a rise of less than 5% had a sensitivity of 72% and a specificity of 62% for multivessel coronary artery disease, while a fall in ejection fraction of 5% or more had a sensitivity of 39% and specificity of 92% for multivessel coronary artery disease. The presence of an exercise wall motion abnormality in the nonadjacent noninfarcted (remote) region had a sensitivity of 82% and specificity of 55% for multivessel coronary artery disease. A more stringent criterion, worsening of remote wall motion with exercise, had a sensitivity of 52% and specificity of 75%. When this latter criterion was combined with a fall in ejection fraction, the sensitivity for multivessel coronary artery disease increased to 62%, specificity remained 75%, and information content increased from 5% to 10%. We conclude that conventional diagnostic criteria for abnormal clinical, bicycle electrocardiographic, or scintigraphic results do not identify patients with additional coronary artery disease after infarction with high accuracy. Two alternative ventriculographic parameters--a fall in ejection fraction and wall motion worsening--are similar to clinical parameters in specificity, but have a higher sensitivity and information content.
为评估预测心肌梗死后多支冠状动脉疾病的替代标准，我们比较了110例心肌梗死后接受冠状动脉造影患者的临床、踏车心电图及放射性核素心室造影（射血分数和室壁运动）反应。110例患者中，97例患有多支冠状动脉疾病（两支或更多病变血管）。97例多支血管疾病患者中有41例观察到临床或心电图异常（敏感性=43%），而13例无多支血管疾病患者中仅有2例出现异常（特异性=85%）。这些临床和心电图联合变量相对于完美区分的平均信息量为5%。在闪烁显像参数中，射血分数异常的传统标准，即升高小于5%，对多支冠状动脉疾病的敏感性为72%，特异性为62%，而射血分数下降5%或更多对多支冠状动脉疾病的敏感性为39%，特异性为92%。非梗死（远隔）区域运动时室壁运动异常对多支冠状动脉疾病的敏感性为82%，特异性为55%。一个更严格的标准，即运动时远隔室壁运动恶化，敏感性为52%，特异性为75%。当后一标准与射血分数下降相结合时，对多支冠状动脉疾病的敏感性增至62%，特异性仍为75%，信息量从5%增至10%。我们得出结论，临床、踏车心电图或闪烁显像结果异常的传统诊断标准不能准确识别梗死后期患有其他冠状动脉疾病的患者。两个替代性心室造影参数——射血分数下降和室壁运动恶化——在特异性方面与临床参数相似，但敏感性和信息量更高。
