| 李玉芸,林 玥,乔雪婷,李春梅,扎西卓玛.低风险胸痛急性冠状动脉综合征患者心电图特征及其对诊断的价值研究[J].,2020,(20):3942-3946 |
| 低风险胸痛急性冠状动脉综合征患者心电图特征及其对诊断的价值研究 |
| Characteristics of Electrocardiogram in Patients with Low-risk Chest Pain and Acute Coronary Syndrome and Its Value in Diagnosis |
| 投稿时间：2020-03-24 修订日期：2020-04-19 |
| DOI：10.13241/j.cnki.pmb.2020.20.031 |
| 中文关键词: 急性冠状动脉综合征 心电图 低风险 ST段偏移值 主要不良心血管事件 |
| 英文关键词: Acute coronary syndrome Electrocardiogram Low risk ST segment offset Major adverse cardiovascular events |
| 基金项目:国家自然科学基金项目（81760329） |
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| 中文摘要: |
| 摘要 目的：分析低风险胸痛急性冠状动脉综合征(acute coronary syndrome，ACS)患者心电图特征及其对诊断的价值。方法：选择我院自2017年1月至2019年8月接诊的194例疑似低风险胸痛ACS患者，均采取心电图检查和冠状动脉造影检查；分析低风险胸痛ACS患者的心电图特征，观察心电图结果与冠状动脉病变支数、狭窄程度的关系，计算心电图诊断低风险胸痛ACS的特异性、敏感性等效能指标，使用受试者工作特征(receiver operating characteristic，ROC)曲线下面积(curve，AUC)定量分析ST段偏移值预测主要不良心血管事件的效能。结果：在194例疑似低风险胸痛ACS患者中，低风险胸痛ACS患者134例，低风险不稳定型心绞痛(UA)患者心电图表现以ST-T缺血性改变为主，发作时改变明显或呈现伪性改善；低风险非ST段抬高的心肌梗死(non-ST-segment elevation myocardial infarction，NSTEMI)患者心电图表现为肢体和胸导联ST段压低，T波低平、倒置，ST-T改变持续存在和呈动态衍变；低风险胸痛ACS患者心电图结果与冠状动脉病变支数无关(P＞0.05)，与狭窄程度有关(P＜0.05)；心电图诊断低风险胸痛ACS的特异性为71.67 %，敏感性为69.40 %，阳性预测值为84.55 %，阴性预测值为51.19 %，符合率为70.62 %；所有患者均获得随访，经ROC曲线分析，ST段偏移值预测低风险胸痛ACS患者发生主要不良心血管事件的最佳截值为1.85 mm，AUC为0.695，对比全球急性冠状动脉事件注册(GRACE)风险评分的0.675，差异无统计学意义(P＞0.05)。结论：低风险胸痛ACS患者心电图具有多样化，与冠状动脉狭窄程度有关，有助于初步诊断和风险评估，且ST段偏移值预测主要不良心血管事件的效能较好，值得进一步研究应用。 |
| 英文摘要: |
| ABSTRACT Objective: To analyze the characteristics of electrocardiogram in patients with low-risk chest pain and acute coronary syndrome(ACS) and its value in diagnosis. Methods: A total of 194 patients with suspected low-risk chest pain ACS who were admitted to our hospital from January 2017 to August 2019 were enrolled, electrocardiogram and coronary angiography were performed, the ECG characteristics of patients with low-risk chest pain were analyzed, the relationship between ECG results and the number of coronary artery lesions and stenosis, the specificity and sensitivity equivalent energy of ECG in the diagnosis of low-risk chest pain by ECG, the area under the receiver operating characteristic (ROC) curve (AUC) was used to quantify the ST segment offset value to predict the efficacy of major adverse cardiovascular events. Results: Among 194 patients with suspected low-risk chest pain, 134 patients with low-risk chest pain ACS, the electrocardiogram of patients with low-risk unstable angina pectoris (UA) is mainly ST-T ischemic change, and the change is obvious or pseudo-improvement, the electrocardiogram of patients with low-risk non-ST-segment elevation myocardial infarction (NSTEMI) showed ST-segment depression in the limb and chest lead, T-wave low-level, inverted, ST-T changes persisted and dynamic evolution.The ECG results of ACS patients with low-risk chest pain are not related to the number of coronary artery lesions(P>0.05), which is related to the degree of stenosis(P<0.05). The specificity of ECG in the diagnosis of low-risk chest pain was 71.67 %, the sensitivity was 69.40 %, the positive predictive value was 84.55 %, the negative predictive value was 51.19 %, and the coincidence rate was 70.62 %. All patients are followed up and analyzed by ROC curve, ST-segment offset predicts the best cutoff for major adverse cardiovascular events in patients with low-risk chest pain in ACS was 1.85 mm, AUC was 0.695, compared with 0.675 for global acute coronary event registration (GRACE) risk score,the difference was not statistically significant(P>0.05). Conclusion: The ECG of patients with low-risk chest pain was diversified, which was related to the degree of coronary artery stenosis, which was helpful for initial diagnosis and risk assessment, the ST segment offset value predicts the main adverse cardiovascular events with better efficacy, worthy of further research and application. |
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