体表心电图预测梗死相关动脉及部位的敏感性和特异性

目的总结体表心电图（ECG）判断ST段抬高心肌梗死（STEMI）患者的梗死相关动脉（IRA）的流程,确定其敏感性、特异性和准确性。方法入选896例STEMI患者。根据公认的ECG判断标准,制订相应流程,判断IRA及其具体部位,并与即刻冠状动脉造影对比,确定流程的敏感性、特异性和准确性。结果判断左主干病变的敏感性为100%、特异性99%和准确性99%;判断前降支病变的敏感性、特异性和准确性分别为99%、99%和99%,其中近段为84%、90%和88%,中远段为57%、94%和88%;判断回旋支病变的敏感性、特异性和准确性分别为64%、95%和91%;判断右冠状动脉病变的敏感性、特异性和准确性为89%、92%和91%,其中近段为51%、96%和88%,中远段为68%、92%和85%。结论本研究的流程可以准确判断左主干、前降支和右冠状动脉近段病变,但区分回旋支和右冠状动脉中远段病变时有一定限度。

Sensitivity and specificity of identification of the infarct-related artery by electrocardiogram

Objective To evaluate the sensitivity,specificity and accuracy of the algorithm for electrocardiographic identification of the IRA and exact site of occlusion of the IRA.Methods According to the algorithm for electrocardiographic identification,we predicted the IRA by analyzing ECG in 896 patients with ST-segment elevation myocardial infarction（STEMI）,who were enrolled in this study and underwent primary coronary angiography.Results The results indicated that left main coronary disease showed a sensitivity of 100% , specificity of 99% and accuracy of 99% ; and at the same time the left anterior descending artery （LAD） with 99%, 99% and 99% （proximal LAD： 84%, 90% and 88%; middle and distal LAD： 57%, 94% and 88%）; the left circumflex artery with 64%, 95% and 91%; the right coronary artery （RCA） ：89% , 92% and 91% （ proximal RCA ： 51% , 96% and 88% ; middle and distal RCA： 68%, 92% and 85% ） respectively. Conclusion This study suggests that electrocardiogram is a crucial tool in the identification of tile IRA in left main coronary, LAD and proximal RCA with predieting exact site of culprit lesion. The LCX or middle and distal RCA can be difficult to discriminate.