Elaerts J, Auloge J P, Blaise C, Carette B, Hécart J, Ostermann G, Bajolet A
Arch Mal Coeur Vaiss. 1982 Sep;75(9):1085-92.
The extent of coronary artery disease after primary myocardial infarction is an important prognostic factor. The predictive value of exercise electrocardiography for multivessel disease was assessed by comparison with coronary angiography in a series of 100 patients. In the group of patients with primary anterior infarction (n = 48), 37.5% had positive exercise ECGs. Coronary angiography showed 62.5% single vessel disease. In multivessel disease, the sensitivity of exercise ECG was 78% and specificity 86%. The predictive value of a positive test was 78% and, for a negative test, 86%. In primary inferior infarction (n = 52), positive exercise ECGs were recorded in 48% of cases. Coronary angiography showed 48% multivessel disease. In multivessel disease, sensitivity of exercise ECG was 92% ans specificity 93%. The predictive value of a positive test was 92% and of a negative test, 93%. Therefore, exercise ECG gives a more precise prediction of the extent of coronary artery disease after primary inferior infarction than after primary anterior infarction. However, it is not an ideal guide for the choice of patient for coronary angiography because of its poor predictive value in cases of anterior infarction, and because of the high incidence of multivessel disease in patients with primary inferior infarcts. Nevertheless, it is of great prognostic value with regards to the eventual course of the coronary disease.
初次心肌梗死后冠状动脉疾病的程度是一个重要的预后因素。通过与冠状动脉造影术对比，在100例患者中评估了运动心电图对多支血管病变的预测价值。在初次前壁梗死患者组（n = 48）中，37.5%运动心电图呈阳性。冠状动脉造影显示62.5%为单支血管病变。在多支血管病变中，运动心电图的敏感性为78%，特异性为86%。阳性检查的预测价值为78%，阴性检查的预测价值为86%。在初次下壁梗死患者组（n = 52）中，48%的病例运动心电图呈阳性。冠状动脉造影显示48%为多支血管病变。在多支血管病变中，运动心电图的敏感性为92%，特异性为93%。阳性检查的预测价值为92%，阴性检查的预测价值为93%。因此，与初次前壁梗死后相比，运动心电图对初次下壁梗死后冠状动脉疾病的程度能给出更精确的预测。然而，由于其在前壁梗死病例中的预测价值较差，且初次下壁梗死患者多支血管病变的发生率较高，所以它并非冠状动脉造影患者选择的理想指导方法。尽管如此，它对于冠状动脉疾病的最终病程具有重要的预后价值。
