Fesmire F M, Percy R F, Bardoner J B, Wharton D R, Calhoun F B
Department of Emergency Medicine, Erlanger Medical Center, University of Tennessee College of Medicine, Chattanooga, USA.
Ann Emerg Med. 1998 Jan;31(1):3-11. doi: 10.1016/s0196-0644(98)70274-4.
To determine whether the use of automated serial 12-lead ECG monitoring (SECG) is more sensitive and specific than the initial 12-lead ECG in the detection of injury and ischemia in patients with acute coronary syndromes (ACS) during the initial ED evaluation of patients with chest pain.
A prospective observational study was performed in 1,000 patients with chest pain who were admitted to a university teaching hospital and who underwent continuous ST-segment monitoring with SECG during the initial ED evaluation. The initial ECG was obtained on presentation, and SECG readings were obtained at least every 20 minutes during the ED evaluation. Diagnostic abnormalities on the initial ECG were defined as injury or ischemia. Diagnostic changes on SECG were defined as evolving injury, evolving ischemia, new injury, or new ischemia. ACS was defined as acute myocardial infarction (AMI), recent myocardial infarction or unstable angina.
A diagnostic SECG was more sensitive than a diagnostic initial ECG for detection of AMI (68.1% versus 55.4%; P < .0001) and ACS (34.2% versus 27.5%; P < .0001). A diagnostic SECG was more specific than a diagnostic initial ECG for detection of ACS (99.4% versus 97.1%; P < .01). SECG detected injury in an additional 16.2% of AMI patients compared with the initial ECG (61.8% versus 45.6%; P < .0001; 95% confidence interval for difference of proportions, 10.9% to 21.4%).
SECG during the initial ED evaluation is more sensitive and more specific than the initial ECG in the identification of ACS. Patients with a diagnostic SECG need intensive antiischemic therapy, evaluation for reperfusion therapy, and admission to an ICU.
确定在胸痛患者的急诊科初始评估中，使用自动连续12导联心电图监测（SECG）在检测急性冠状动脉综合征（ACS）患者的损伤和缺血方面是否比初始12导联心电图更敏感和特异。
对1000例胸痛患者进行了一项前瞻性观察性研究，这些患者被收入一所大学教学医院，并在急诊科初始评估期间接受SECG连续ST段监测。就诊时获取初始心电图，在急诊科评估期间至少每20分钟获取一次SECG读数。初始心电图上的诊断异常定义为损伤或缺血。SECG上的诊断变化定义为进展性损伤、进展性缺血、新损伤或新缺血。ACS定义为急性心肌梗死（AMI）、近期心肌梗死或不稳定型心绞痛。
诊断性SECG在检测AMI方面比诊断性初始心电图更敏感（68.1%对55.4%；P <.0001），在检测ACS方面也是如此（34.2%对27.5%；P <.0001）。诊断性SECG在检测ACS方面比诊断性初始心电图更特异（99.4%对97.1%；P <.01）。与初始心电图相比，SECG在另外16.2%的AMI患者中检测到损伤（61.8%对45.6%；P <.0001；比例差异的95%置信区间为10.9%至21.4%）。
在急诊科初始评估期间，SECG在识别ACS方面比初始心电图更敏感、更特异。有诊断性SECG的患者需要强化抗缺血治疗、评估再灌注治疗并入住重症监护病房。
