胸痛及心肌缺血心电图对冠心病诊断价值比较

目的比较胸痛、心肌缺血心电图改变对冠心病的诊断价值。方法选取832例冠脉造影病例，依据胸痛、心肌缺血心电图改变分成2组，行常规12导联ECG检查，并加做V3R、V4R、V5R导联及冠脉造影，进行患者胸痛、缺血心电图及冠脉造影比较。结果典型胸痛诊断冠心病特异度64．7％，阳性预测值82．2％．缺血心电图灵敏度64．6％、特异度36．7％、阴性预测值54．7％。ST段压低或抬高阳性预测值66．1％、T波倒置阳性预测值31．3％、缺血心电图并典型胸痛灵敏度70．3％、缺血心电图并不典型胸痛诊断冠心病的的特异度34．5％。结论典型胸痛诊断冠心病特异度高，阳性预测价值大，误诊率低，典型胸痛者冠心病的可能性大；缺血心电图敏感性高而特异性低，阴性预测价值更大，单凭其诊断冠心病有一定的片面性；ST段压低或抬高诊断价值优于单纯T波改变，缺血心电图合并典型胸痛灵敏度高，漏诊率低，缺血心电图合并不典型胸痛特异度低、误诊率高。

Comparison of the value of angina pectoris and myocardial ischecmic(ECG) in diagnosis coronary artery disease(CAD)

0bjective To Study the value of angina pectoris and change of electrocardiogram(ECG)in diagnosis of coronary artery disease(CAD). Methods 832 cases performed coronary angiography(CAG)were enrolled.According to angina pectoris and change of electrocardiograrm(ECG),all cases were divided into two groups, every patient received twelve normal leads electriccardiography, andV3R, V4R, V5R leads.Compared angina pectoris and change of electrocardiograrm(ECG) with coronary angiography. Results Specificity which diagnosis coronary heart disease in angina pectoris group was64.7%,positive predictive value was 82.2%, sensitivity of myocardial ischecmic(ECG) was 64.6%, specificity was 36.7%, positive predictive value was 47.0%, positive predictive value of ST segment depression or raise was 66.1%, positive predictive value of T wave inversion was 31.3%, myocardial ischecmic(ECG) with angina pectoris group sensitivity was 70.3%, myocardial ischecmic(ECG) with atypical chest pain group specificity was 34.5%. Conclusion 1. angina pectoris diagnosis coronary heart disease specificity is high, positive predictive value is high, mistake diagnostic rate is low, angina pectoris have coronary heart disease possibility is great, myocardial ischecmic(ECG) diagnosis coronary heart disease sensitivity is great, specificity is low, negative predictive value is better, if diagnosis coronary heart disease with this alone, it will be one-sidedness,The value which diagnosis coronary heart disease with ST segment depression or raise is better than singl T wave change, angina pectoris and myocardial ischecmic(ECG) diagnosis coronary heart disease sensitivity is high, omission diagnostic rate is low, specificity is low, nonangina pectoris and myocardial ischecmic(ECG) diagnosis coronary heart disease specificity is low, mistake diagnostic rate is high.