Zalenski R J, Cooke D, Rydman R, Sloan E P, Murphy D G
Department of Emergency Medicine, Cook County Hospital, Chicago, IL.
Ann Emerg Med. 1993 May;22(5):786-93. doi: 10.1016/s0196-0644(05)80792-9.
To assess sensitivity, specificity, and odds ratios of ECG findings on leads V4R, V8, and V9 for acute myocardial infarction.
Prospective, two-stage cohort study.
A 660-bed university-affiliated community hospital.
One hundred forty-nine admitted patients with suspected myocardial infarction or unstable angina.
Standard 12-lead ECG followed immediately by V4R, V8, and V9.
Initial ECG findings of ST-segment displacement, Q waves, T-wave inversion, and eligibility for thrombolytic therapy.
Major abnormalities (ST-segment deviation, T-wave inversion, Q waves) were found on the extra three leads in 28.9% (43 of 149) of patients. Sensitivity of ST-segment elevation for acute myocardial infarction on 12 versus 15 leads increased from 47.1% to 58.8%, respectively, with no decrease in specificity. McNemar's pair-matched analysis for ST-segment elevation on myocardial infarction subgroup showed an association of ST elevation with the 15-lead ECG (P < .05). An eightfold increase in the odds of detecting ST elevation was found (90% confidence interval, 1.42 to 14.58); 22% of patients negative for ST elevation on 12 leads were positive on 15 leads. Analysis of ECG criteria for thrombolytic therapy presenting uniquely on extra leads showed an increased sensitivity from 35.3% to 44.1% on 12 versus 15 leads, respectively; there was a sixfold increase in the odds of meeting ECG thrombolytic therapy criteria (90% confidence interval, 0.34 to 11.66); 13.5% of patients not meeting criteria on 12 leads did so on 15 leads.
The 15-lead ECG provides increased sensitivity and odds of detecting ST-segment elevation in acute myocardial infarction patients with no loss of specificity; its use may expand the selection of thrombolytic therapy candidates and provide a fuller ECG description of the extent of myocardial injury and necrosis.
评估V4R、V8和V9导联心电图表现对急性心肌梗死的敏感性、特异性和比值比。
前瞻性两阶段队列研究。
一家拥有660张床位的大学附属医院。
149例疑似心肌梗死或不稳定型心绞痛的住院患者。
先进行标准12导联心电图检查，随后立即进行V4R、V8和V9导联心电图检查。
ST段移位、Q波、T波倒置的初始心电图表现以及溶栓治疗的 eligibility。
28.9%（149例中的43例）患者的额外三个导联发现主要异常（ST段偏移、T波倒置、Q波）。急性心肌梗死时，12导联与15导联ST段抬高的敏感性分别从47.1%提高到58.8%，特异性未降低。对心肌梗死亚组ST段抬高进行McNemar配对分析显示，ST段抬高与15导联心电图相关（P < 0.05）。检测ST段抬高的比值比增加了8倍（90%置信区间，1.42至14.58）；12导联ST段抬高阴性的患者中有22%在15导联为阳性。对额外导联上独特出现的溶栓治疗心电图标准进行分析显示，12导联与15导联的敏感性分别从35.3%提高到44.1%；符合心电图溶栓治疗标准的比值比增加了6倍（90%置信区间，0.34至11.66）；12导联不符合标准的患者中有13.5%在15导联符合标准。
15导联心电图可提高急性心肌梗死患者检测ST段抬高的敏感性和比值比，且不降低特异性；其应用可能扩大溶栓治疗候选者的选择范围，并更全面地描述心肌损伤和坏死的程度。
