200例急性冠脉综合征患者冠状动脉造影及临床特点分析

目的 探讨200例急性冠脉综合征(ACS)患者冠状动脉造影及临床特点.方法 对200例确诊为ACS的患者进行冠状动脉造影,15例冠状动脉造影正常者为观察组,183例(2例心肌桥患者排除)冠状动脉造影(CAG)异常符合冠心病病理标准者为对照组.结果 观察组平均年龄明显低于对照组,以青壮年男性为主,高血压痛、高血脂、糖尿病较对照组明显降低,吸烟、过度精神刺激较对照组明显增多;现察组静态发病率,心电图运动试验假阴性率、核素灌注心肌显像负荷试验中的反相再分布率显著高于对照组,CAG过程中冠脉痉挛发生率高.结论 在冠脉造影正常的ACS中,ACS发作可能与冠脉痉挛伴或不伴继发血栓形成相关.     

壁冠状动脉心肌桥的造影和临床分析

目的:观察、分析壁冠状动脉(冠脉)和心肌桥的临床特点与诊断、治疗方法。方法:观察、分析经冠脉造影确诊的96例109处心肌桥患者的心肌桥分布特点、临床症状、心电图、心肌酶谱、肌钙蛋白T、心脏超声,评价药物或支架治疗心肌桥的疗效。结果:心电图、临床症状、心肌酶谱、肌钙蛋白T和心脏超声对心肌桥的诊断均无特异性。造影发现93.7%的心肌桥发生于冠脉前降支(LAD)。心肌桥患者临床症状与收缩期狭窄程度有关。药物治疗、手术治疗均有一定疗效。结论:冠脉造影发现"收缩期狭窄"为目前确诊心肌桥的主要方法。心肌桥与心绞痛、动脉粥样硬化、心肌梗死的发生有密切关系。药物治疗可选用肾上腺素β受体阻滞剂和Ca2+拮抗剂。     

心肌桥患者影像、心电图及相关临床特点分析

目的 分析经冠脉造影证实的86例心肌桥患者冠脉造影特点,研究其与心电图、活动平板、Holter之间的关系特征,观察药物对心肌桥的症状改善情况.方法 所有患者进行常规18导联冠状动脉造影检查、心电图检查,67例行Holter检查,56例行活动平板运动试验检查,分析其相互关系.结果 在所有566例冠脉造影患者中,检出心肌桥86例,共有心肌桥93处,检出率为15.2％.心肌桥长度9 mm～30 mm(14.3 mm±6.5 mm),Nobel分级1级57例,64处;2级28例,28处;3级1例,1处.单处心肌桥80例,两处心肌桥5例,3处心肌桥1例.提示心肌桥单处病变,1级病变较多.随心肌桥长度及收缩期狭窄程度加重,心电图ST -T改变,活动平板及Holter改变明显随之加重.单纯钙拮抗剂及β受体阻滞剂效果良好.结论 单处及1级心肌桥居多,且主要分布于前降支,相伴与心肌桥可见不同程度ST -T改变,各种类型心律失常.心电图ST段下移程度随心肌桥长度加长及受压迫程度加重而明显加重,且心律失常频度和活动平板阳性率都随心肌桥受压程度增加而明显增加,单纯钙拮抗剂及β受体阻滞剂效果良好.     

心肌桥患者心电图及平板运动试验结果分析

目的探讨心肌桥患者冠状动脉造影特点及心电图和平板运动试验的变化。方法回顾分析冠状动脉造影术的3168例患者中,96例心肌桥患者冠状动脉造影特点及心电图和平板运动试验的变化。结果冠状动脉造影心肌桥的检出率为3.0%,位于左前降支85例(88.5%),其中3例患者左前降支有2处心肌桥存在;6例(6.3%)发生在右冠状动脉;4例(4.2%)发生在左回旋支;1例(1.0%)发生在左后降支。96例心肌桥患者中,26例(27.1%)有缺血性ST段和T波改变,70例心电图正常。心肌桥深度:浅表型70例(72.9%),深在型26例(27.1%);心肌桥长度:6～15mm 31例(32.3%)、16～34mm 65例(67.7%)。依据Nobe1分级法,Ⅰ级22例(22.9%),Ⅱ级64例(66.7%),Ⅲ级10例(10.4%)。结论心肌桥患者心肌缺血与心肌桥长度和深度及运动相关。     

冠状动脉心肌桥的临床诊断与治疗

目的:探讨心肌桥的影像特征及临床治疗方法。方法:回顾性分析317例冠状动脉(冠脉)造影中检出的11例心肌桥患者的临床资料。结果:心肌桥发生率为3.5%,其中单桥10例,均位于前降支;双桥1例,位于前降支及回旋支。临床诊断孤立性心肌桥6例,并发冠脉粥样硬化3例,并发高血压4例。11例心肌桥患者中10例有发作性胸痛症状,另1例有心律失常,经治疗后胸痛患者症状明显缓解,心律失常者恢复正常。结论:选择性冠脉造影可用于心肌桥的诊断,心肌桥可能引起心肌缺血表现,应用β受体阻滞剂等药物或支架置入术治疗心肌桥患者有效。     

运动诱发ST段抬高者的冠状动脉病变特点及治疗探讨

目的 :观察无心肌梗死 (MI)运动诱发心电图ST段抬高者 6例 ,探讨其冠状动脉 (冠脉 )病变特点及治疗方法。方法 :对无MI而运动诱发心电图ST段抬高的患者进行静息心电图、运动试验及冠脉造影检查 ,运动试验采用Bruce方案。结果 :在 2 86 4例行运动试验检查者中 ,有 6例未患MI而运动诱发心绞痛伴心电图ST段抬高 ,发生率为 0 .2 1%。相应导联ST段抬高 0 .1～ 1.0mV ,停止运动后心绞痛症状消失 ,ST段恢复正常。 6例中 ,1例冠脉病变轻 (狭窄 <35 % ) ,但于冠脉造影后 4周发生急性MI ,梗死部位与ST段抬高导联所对应的部位一致 ;余 5例冠脉均有严重狭窄 (90 %～ 10 0 % ) ,ST段抬高导联与缺血相关血管有良好的对应关系 ,近期内行冠脉腔内球囊成形术效果良好 ,术后症状消失 ,多次复查运动试验 ,结果均阴性。结论 :无MI患者运动诱发心电图ST段抬高多提示心肌透壁缺血 ,冠脉病变重 ,预后差 ,应采取积极的治疗措施。     

急性心肌梗死患者与冠状动脉造影阴性患者躯体化症状、焦虑及抑郁状态的调查分析

目的调查分析急性心肌梗死患者与冠状动脉(冠脉)造影阴性患者躯体化症状、焦虑及抑郁状态。方法连续调查2016年6月至12月于上海市某三甲医院心内科住院行冠脉造影患者1353例,选取冠脉造影结果阴性者为冠脉阴性组(676例),同期选取急性心肌梗死(AMI)患者为心梗组(150例)。采用躯体化症状自评量表(SSS)、广泛性焦虑障碍量表(GAD-7)及患者健康问卷抑郁自评量表(PHQ-9)对患者进行心理测评,比较心梗组及冠脉造影阴性组躯体化症状及焦虑抑郁状态的患病情况。结果与急性心梗组相比,冠脉阴性组躯体化症状阳性率高(32.8%vs.22.7%,P=0.014),躯体化症状量表分值高(32.7±8.45 vs.30.29±8.03,P=0.0015);冠脉造影阴性患者焦虑状态阳性率高于AMI患者(18.3%vs.9.3%,P=0.0074);冠脉造影阴性患者抑郁及焦虑评分分值高于AMI患者(P<0.05);冠脉造影阴性患者非特异性躯体化症状均高于AMI(P<0.05)。结论冠脉造影阴性患者的躯体化症状及焦虑状态的阳性率高于AMI患者,特别是对于伴非特异躯体症状的冠脉造影阴性患者,及早识别此类患者的躯体化症状可能对临床上进一步治疗提供帮助。     

高血压病前期患者平板运动试验的价值

目的研究并发心前区疼痛发作的高血压病前期患者平板运动实验的特点.方法71例有心前区疼痛发作的高血压病(HP)患者与64例有心前区疼痛发作的高血压病前期患者,均进行平板运动试验及冠状动脉(冠脉)造影检查.结果二组敏感性(82.6%,86.5%),阴性预测值(65.2%,75.0%),血压升高幅度差异无统计学意义(P>0.05);而特异性(83.3%,44.19%),阳性预测值(92.6%,62.7%),准确性(82.8%,66.2%),高血压病前期组高于HP组(P<0.05).HP组患者平板运动试验发生心电图ST段下移时间比高血压病前期组延迟出现(P<0.01).其冠脉造影阳性组最大ST段下移幅度大于冠脉造影阴性组(P<0.05).结论高血压病前期患者运动试验假阳性率低,这部分患者平板运动试验心电图ST段下移即时出现,且最大ST段下移幅度大.     

潘生丁核素心肌灌注显像在X综合征中的应用

核素心肌灌注显像已广泛用于冠心病患者的临床评价 ,本文报告 X综合征 44例应用潘生丁心肌灌注显像 ,现将结果报告于下。1　资料与方法1 .1　临床资料1 .1 .1　 X综合征患者 44例 ,其中男 2 0例 ,女 2 4例 ,年龄 42～ 60岁 (平均 5 2 .9± 8.2岁 ) ,所有病例符合下列诊断标准 [1] :1有典型劳累性心绞痛发作 ;2有心肌缺血依据 ,包括静息或负荷心电图运动试验阳性 ( ST段下移≥ 1 mm) ;3冠状动脉造影阴性 ;4无冠状动脉痉挛 ;5排除可导致心电图缺血改变的其它心脏病。1 .1 .2　对照组 :选择临床有典型心绞痛症状 ,并经冠状动脉造影 (冠脉造影…     

心肌桥合并冠状动脉痉挛患者的临床特点

目的 探讨心肌桥合并冠状动脉痉挛患者的临床特征及其与血管内皮细胞功能的关系.方法 接受冠状动脉痉挛激发试验的118例患者,根据冠状动脉造影显示是否合并心肌桥分为肌桥组(n=26)和非肌桥组(n=92),比较两组乙酰胆碱试验、运动心电图、核素灌注心肌显像负荷试验的结果及血浆内皮素1和一氧化氮水平.结果 肌桥组乙酰胆碱试验阳性21例(81%),非肌桥组乙酰胆碱试验阳性52例(57%,P＜0.05);心电图运动试验阳性者两组分别为19例(73%)和7例(8%,P＜0.001),核素灌注心肌显像负荷试验显示缺血性改变者两组分别为20例(77%)和9例(10%,P＜0.001),反相再分布分别为23例(88%)和68例(74%,P＞0.05),两组患者的临床症状发作特点亦显著不同,肌桥合并痉挛患者的内皮素水平明显增高[(132.1±6.5)ng/L比(108.5±8.2)ng/L,P＜0.01],而一氧化氮水平明显降低[(84.7±17.5)ng/L比(99.8±18.2)ng/L,P＜0.05].结论 心肌桥患者易发生冠状动脉痉挛,可能与血管内皮细胞功能紊乱有关,该类患者多具有特征性的临床表现和心脏负荷试验结果.     

心肌桥临床特点分析

目的:观察分析心肌桥的临床特征,为临床上心肌桥的正确诊断与治疗提供参考。方法:采用选择性冠状动脉造影方法,检测心肌桥患者120例,男75例,女45例,年龄30~63岁。结果:120例具有胸闷,胸痛,心悸等症状。87例(72.5%)有不同程度的心电图异常;前降支肌桥114例(95%),回旋支肌桥6例(5%)。狭窄Ⅰ级:6例(5%),Ⅱ级:78例(65%),Ⅲ级:36例(30%)。120例中,药物治疗117例,置入支架3例。随访1年,大部分患者症状减轻,无恶化及死亡病例。结论:心肌桥并非罕见现象,随着年龄的增长可出现不同的临床症状,治疗应首选药物治疗。     

Can exercise electrocardiography and thallium-201 myocardial imaging exclude the diagnosis of coronary artery disease?: Bayesian analysis of the clinical limits of exclusion and indications for coronary angiography

The objective of this study was to determine whether exercise electrocardiography can be combined with thallium-201 myocardial imaging and the clinical history to exclude the diagnosis of coronary artery disease. All 96 patients in this study were referred for coronary angiography because of chest pain but did not have prior myocardial infarction; 52 percent had coronary artery disease. Each patient's chest pain was classified as either typical or not typical of angina pectoris. Negative tests with inadequate exercise stress (less than 85 percent of the age-predicted maximal heart rate) and combined tests with discordant results (either exercise electrocardiography or thallium imaging positive and the other test negative) were judged nondiagnostic. Nondiagnostic tests that contributed most to the uncertainty of results were classified separately: exercise electrocardiogram, 35 patients; thallium imaging, 9 patients; and combined exercise electrocardiogram and thallium imaging, 50 patients. The ability of each test to rule out coronary artery disease was defined by its predictive error (probability of coronary disease despite a negative test): history of chest pain not typical of angina, 26 percent (11 of 42); exercise electrocardiogram, 22 percent (5 of 23); thallium imaging, 27 percent (6 of 35); and negative findings on both exercise electrocardiogram and thallium imaging, 6 percent (1 of 17). Finally, when only the patients with atypical chest pain were considered, there was zero (0 of 15) predictive error if both tests were negative.Negative exercise electrocardiography and thallium imaging during adequate stress ruled out any coronary artery disease in these patients with considerable reliability (94 percent) and excluded multivessel disease with even greater reliability. These exclusion tests for coronary artery disease were most reliable in patients in whom the clinical diagnosis of coronary artery disease was least likely, as defined by Bayes' theorem. It is concluded that there is no perfect noninvasive test to exclude coronary disease in all patient populations; however, coronary angiography is not necessary to rule out the diagnosis of coronary artery disease in patients who'have (1) no clinical indicators of a very high probability of coronary disease, such as typical angina, (2) adequate exercise stress, (3) negative exercise electrocardiogram and (4) negative exercise thallium images.     

Safety and prognostic value of early dobutamine-atropine stress echocardiography in patients with spontaneous chest pain and a non-diagnostic electrocardiogram.

AIMS: To risk stratify and shorten hospital stay in patients with spontaneous (resting) chest pain and a non-diagnostic electrocardiogram (ECG). METHODS AND RESULTS: The study comprised 102 patients (mean age 58+/-12 years, 67 men) with spontaneous chest pain and a non-diagnostic ECG. Forty-three patients had suspected coronary artery disease and 59 had known (but of unknown actual significance) coronary artery disease. All patients underwent serial creatine kinase enzyme measurements, continuous ECG monitoring for at least 12 h and early dobutamine-atropine stress echocardiography in patients with negative creatine kinase enzymes and normal findings at ECG monitoring. Dobutamine-atropine stress echocardiography was considered positive in patients with new or worsening wall thickening abnormalities. Patients with negative dobutamine-atropine stress echocardiography were discharged after the test. In-hospital and 6 month follow-up events noted were cardiac death, non-fatal myocardial infarction, unstable angina, and coronary artery bypass surgery or angioplasty. Thirteen patients had evidence of evolving myocardial infarction by elevated creatine kinase enzymes, or unstable angina by ECG monitoring. In the remaining 89 patients, dobutamine-atropine stress echocardiography was performed after a median observation period of 31 h (range 12-68 h). During dobutamine-atropine stress echocardiography no serious complications (death, non-fatal myocardial infarction, sustained ventricular tachycardia or ventricular fibrillation) occurred. Dobutamine-atropine stress echocardiography results were of poor quality in three, non-diagnostic in six, negative in 44 and positive in 36 patients. In the 80 patients with diagnostic dobutamine-atropine stress echocardiography, variables associated with in-hospital events (n=7) were history of exertional angina (P<0. 005), chest pain score (P<0.005), stress-induced angina (P<0.001) and positive dobutamine-atropine stress echocardiography (P<0.005). Variables associated with follow-up events (n=11) were history of exertional angina (P<0.05), chest pain score (P<0.001), stress-induced angina (P<0.01) and positive dobutamine-atropine stress echocardiography (P<0.01). At multivariate analysis the only significant predictor of events was positive dobutamine-atropine stress echocardiography (P<0.01). CONCLUSION: Early dobutamine-atropine stress echocardiography may safely distinguish between low- and high-risk subsets for subsequent cardiac events in patients with spontaneous chest pain and a non-diagnostic ECG.     

69例冠状动脉心肌桥临床分析

目的　分析冠状动脉造影病人中心肌桥的发生率以及临床特征。方法和结果　 1678例行选择性冠状动脉造影术的人群中 ,共检出心肌桥 69例 ,发生率为 4.11%。均为左冠状动脉前降支 ( L AD)心肌桥。位于 L AD近段 1例 ,中段 5 7例 ,远段 11例。伴有冠心病的心肌桥 13例 ,伴有瓣膜病 3例 ,伴有心肌病 3例 ,无伴随心脏病的孤立心肌桥5 0例。孤立心肌桥中收缩期冠状动脉狭窄程度≥ 70 % 2 5例 ,5 0 %～ 70 % 17例 ,<5 0 % 8例。孤立心肌桥中有胸痛症状 2 5例 ;心电图提示有 ST- T改变 18例 ;行运动负荷试验阳性 18例。 69例心肌桥中超声心动图或左心室造影提示有室壁肥厚 13例。结论　冠状动脉造影是心肌桥的可靠检出手段。心肌桥可伴随其他心脏病发生也可孤立存在。心肌桥引起冠状动脉收缩期的高度狭窄而导致心肌缺血症状、心电图 ST- T变化、运动负荷试验阳性 ,狭窄程度越重 ,上述表现越显著     

Diagnostic work-up of unselected patients with suspected coronary artery disease: complementary role of multidetector computed tomography, symptoms and electrocardiogram stress test

AIM: We evaluated the accuracy of multidetector computed tomography in detecting coronary artery disease and how it could change the indication to coronary angiography in patients with suspected cardiac chest pain. METHODS AND RESULTS: We enrolled 142 consecutive patients who had already performed an exercise electrocardiogram test referred to our hospital and scheduled for coronary angiography for chest pain. According to the characteristics of chest pain and the results of exercise electrocardiogram, patients were divided into four groups: atypical chest pain and negative exercise electrocardiogram (group 1); typical chest pain and negative exercise electrocardiogram (group 2); atypical chest pain and positive exercise electrocardiogram (group 3); and typical chest pain with positive exercise electrocardiogram (group 4). We evaluated the accuracy of multidetector computed tomography and whether it could reduce the number of unnecessary coronary angiography in the study groups. Of 1801 segments larger than 1.5 mm, 1696 (94%) were assessable. In a segment based-model, sensitivity, specificity, negative predictive value, positive predictive value and accuracy were 81% (95% confidence interval 75-89%), 94% (95% confidence interval 90-98%), 96% (95% confidence interval 93-98%), 75% (95% confidence interval 69-82%) and 91% (95% confidence interval 89-93%), respectively. In a patient-based model, sensitivity, specificity, negative predictive value, positive predictive value and accuracy were 95% (95% confidence interval 91-99%), 78% (95% confidence interval 67-89%), 88% (95% confidence interval 79-97%), 89% (95% confidence interval 83-95%) and 89% (95% confidence interval 84-94%). Unnecessary coronary angiography may be avoided by multidetector computed tomography results particularly in group 2 (16%) and group 3 (24%), whereas in groups 1 and 4 the role of multidetector computed tomography in facilitating the correct indication to coronary angiography was less relevant. CONCLUSIONS: Multidetector computed tomography is a particularly helpful technique in patients with discordance between the clinical features of chest pain and stress-test results. This technique may be introduced in the diagnostic work-up of patients with suspected coronary artery disease and may potentially reduce the number of unnecessary coronary angiography.     

The prognostic value of markers of inflammation in patients with troponin T-negative chest pain before discharge from the emergency department

PURPOSE: To assess the prognostic value of markers of inflammation for rule-out purposes in patients admitted to the emergency department with troponin T-negative chest pain. METHODS: Patients presenting to the emergency department within 6 hours of symptom onset and who had a normal or nondiagnostic electrocardiogram were eligible. The standard rule-out protocol, which included serial creatine kinase and creatine kinase-MB measurements, was applied, and markers of inflammation (C-reactive protein, erythrocyte sedimentation rate, and total white blood cell count and differential count) were measured. The study group comprised patients with negative serial troponin T results (<0.06 microg/L) who were discharged home after unstable coronary artery disease was ruled out. Endpoints during the 6-month follow-up were cardiac death, myocardial infarction, or rehospitalization for unstable angina. RESULTS: A total of 382 troponin T-negative patients were discharged, of whom 2 died, 2 had a myocardial infarction, and 7 were rehospitalized for unstable angina. A positive C-reactive protein test result (>0.3 mg/dL) was associated with future clinical events (hazard risk [HR] = 4.5; 95% confidence interval [CI]: 1.2 to 17.0; P = 0.03), as was a positive test (>13 mm/h) for erythrocyte sedimentation rate (HR = 5.6; 95% CI: 1.5 to 22.2; P = 0.01). Patients with positive results for both tests were at highest risk of clinical events (9.3%) compared with patients with other combinations of test results (1.1% to 2.1%; HR = 7.5; 95% CI: 2.2 to 25.5; P = 0.001). CONCLUSION: The combination of C-reactive protein and erythrocyte sedimentation rate had prognostic value in patients with troponin T-negative chest pain and a normal or nondiagnostic electrocardiogram in whom unstable coronary artery disease was ruled out.     

Prognostic value of predischarge dobutamine stress echocardiography in chest pain patients with a negative cardiac troponin T

OBJECTIVES: We prospectively studied the prognostic value of predischarge dobutamine stress echocardiography (DSE) in low-risk chest pain patients with a normal or nondiagnostic electrocardiogram (ECG) and a negative serial troponin T. BACKGROUND: Noninvasive stress testing is recommended before discharge or within 72 h in patients with low-risk chest pain. The prognostic value of immediate DSE has not been studied in a blinded, prospective fashion. METHODS: Patients presenting at the emergency room within 6 h of symptom onset and a normal or nondiagnostic ECG were eligible. Dobutamine stress echocardiography was performed after unstable coronary artery disease was ruled out by a standard rule-out protocol and a negative serial troponin T; the occurrence of any new wall motion abnormality was considered positive. Results were kept blinded. End points were cardiac death, myocardial infarction, rehospitalization for unstable angina or revascularization. RESULTS: In total, 377 patients were included. There were 2 deaths, 2 myocardial infarctions, 8 rehospitalization for unstable angina, and 10 revascularizations at six-month follow-up. The end points occurred in 8/26 (30.8%) patients with a positive versus 14/351 (4.0%) patients with a negative DSE (odds ratio, 10.7; 95% confidence interval, 4.0 to 28.8; p < 0.0001). By multivariate analysis, DSE remained a predictor of end points (p < 0.0001). CONCLUSIONS: A predischarge DSE had important, independent prognostic value in low-risk, troponin negative, chest pain patients.     

Usefulness of two-dimensional echocardiography for immediate detection of myocardial ischemia in the emergency room

Inappropriate discharge from the emergency room of patients with acute chest pain may have serious consequences. Regional asynergy is one of the first signs of myocardial ischemia and can be detected with 2-dimensional echocardiography (2-DE). This study determines the value of 2-DE in the emergency room for immediate detection of myocardial ischemia causing acute chest pain at the time the electrocardiogram was nondiagnostic. Forty-three patients (32 men and 11 women) with a normal or nondiagnostic electrocardiogram during acute chest pain were studied with 2-DE. Only patients without a previous myocardial infarction and without known coronary artery disease (CAD) were studied. The entire left ventricular wall was examined for presence of regional asynergy. Coronary angiography was performed within 3 weeks. Cardiac enzyme levels were measured serially to establish or rule out an acute myocardial infarction. Sensitivity of 2-DE for detection of myocardial ischemia was 88% (22 of 25), specificity 78% (14 of 18), negative predictive accuracy 82% (14 of 17) and positive predictive accuracy 85% (22 of 26). Sensitivity of 2-DE for detection of acute myocardial infarction was 92% (12 of 13), specificity 53% (16 of 30) and negative predictive accuracy 94% (16 of 17). Thus, 2-DE during pain and a nondiagnostic electrocardiogram can readily identify patients with CAD in the emergency room, and it can accurately rule out an acute myocardial infarction.     

平板运动试验不同导联ST改变对冠心病的诊断价值

目的:总结平板运动试验中不同导联ST改变对冠心病的诊断价值。方法:2001年1月至2005年12月在我科行平板运动试验阳性患者300例,进行了冠脉造影检查,回顾性总结分析其平板运动试验中不同导联ST段变化对冠心病的诊断价值。结果:平板运动试验阳性患者300例。冠脉造影检查阳性231例,其中肢体导联阳性组37例,胸导联阳性组89例,肢体导联 胸导联阳性组105例,胸导联ST改变较单纯肢体导联ST改变有显著的差异性(P<0.05)。结论:平板运动试验诊断中胸导联ST改变较单纯肢体导联ST改变对冠心病的诊断有较好的预测价值。     

Usefulness of ST-segment changes in ≥2 leads on the emergency room electrocardiogram in either unstable angina pectoris or non-Q-wave myocardial infarction in predicting outcome

To determine the reliability of the admission electrocardiogram in predicting outcome in patients hospitalized for chest pain at rest, 90 patients were randomized into a trial of aspirin versus heparin in unstable angina or non-Q-wave myocardial infarction, and prospectively followed for 3 months. The emergency room admission electrocardiogram was analyzed for ST-segment deviation ≥1 mm/lead and T-wave changes. Unfavorable outcomes were recurrent ischemic pain, myocardial infarction and coronary revascularization with angioplasty or surgery. In patients who underwent coronary arteriography, a myocardium in jeopardy score ranging from 0 to 10 was assigned, based on the number of vessels with a diameter stenosis ≥70% and the location of the stenoses. Considering all 90 patients, an admission electrocardiogram with ST-segment deviation in ≥2 leads had a positive predictive value for adverse clinical events of 79% and a negative predictive value of 64%. In the subset of patients without left ventricular hypertrophy and whose admission electrocardiograms were recorded during chest pain (62 of 90), the positive predictive value of ST deviation in ≥2 leads improved to 89% and the negative value to 72%. Of the 62 patients, 53 underwent coronary arteriography. There was a positive linear correlation between the total number of leads with ST-segment deviation and the myocardium in jeopardy score (r = 0.80, p < 0.001). In patients with unstable angina or non-Q-wave myocardial infarction, an admission electrocardiogram recorded during pain and revealing ST-segment changes in ≥2 leads is by itself a reliable predictor of major clinical events. The total number of leads with ST changes predicts the extent of myocardium in jeopardy.