Diagnostic and prognostic value of ST-segment deviation scores in suspected acute myocardial infarction

被引：4

作者：

Grimm, Karin ^{[1
,2
,3
]}

Twerenbold, Raphael ^{[1
,2
]}

Abaecherli, Roger ^{[1
,2
,4
]}

Boeddinghaus, Jasper ^{[1
,2
,3
]}

Nestelberger, Thomas ^{[1
,2
]}

Koechlin, Luca ^{[1
,2
]}

Troester, Valentina ^{[1
,2
,3
]}

Bourtzou, Anna ^{[1
,2
]}

Keller, Dagmar, I ^{[5
]}

Geigy, Nicolas ^{[6
]}

Kozhuharov, Nikola ^{[1
]}

Wussler, Desiree ^{[1
,3
]}

Wildi, Karin ^{[1
,2
]}

Hillinger, Petra ^{[1
]}

Rubini Gimenez, Maria ^{[1
,2
,7
,8
]}

Strebel, Ivo ^{[1
]}

Badertscher, Patrick ^{[1
,2
]}

Puelacher, Christian ^{[1
,2
,3
]}

de Lavallaz, Jeanne du Fay ^{[1
,2
]}

Osswald, Luca ^{[1
]}

Morawiec, Beata ^{[9
]}

Kawecki, Damian ^{[9
]}

Miro, Oscar ^{[10
]}

Kuehne, Michael ^{[1
]}

Reichlin, Tobias ^{[1
,2
,11
]}

Mueller, Christian ^{[1
,2
]}

机构：

[1] Univ Hosp Basel, Dept Cardiol & Cardiovasc, Res Inst Basel CRIB, Basel, Switzerland

[2] Global Res Acute Condit Team GREAT Network, Rome, Italy

[3] Univ Hosp Basel, Dept Internal Med, Basel, Switzerland

[4] Lucerne Univ Appl Sci & Arts, Inst Med Engn, Luzern, Switzerland

[5] Univ Hosp Zurich, Emergency Dept, Zurich, Switzerland

[6] Kantonsspital Baselland, Emergency Dept, Binningen, Switzerland

[7] Hosp Mar Inst Municipal Invest Med, Serv Urgencias & Pneumol, Barcelona, Spain

[8] Leipzig Heart Ctr, Leipzig, Germany

[9] Med Univ Silesia, Dept Cardiol 2, Katowice, Poland

[10] Univ Barcelona, Emergency Dept, Hosp Clin, IDIBAPS, Barcelona, Catalonia, Spain

[11] Univ Bern, Bern Univ Hosp, Dept Cardiol, Inselspital, Bern, Switzerland

来源：

EUROPEAN HEART JOURNAL-ACUTE CARDIOVASCULAR CARE | 2020年 / 9卷 / 08期

基金：

瑞士国家科学基金会;

关键词：

Acute coronary syndrome; electrocardiogram; ST-segment deviation; SENSITIVITY CARDIAC TROPONIN; ACUTE CORONARY SYNDROMES; ADMISSION ELECTROCARDIOGRAM; INITIAL ELECTROCARDIOGRAM; RULE-IN; ELEVATION; PREDICTION; SIZE; COMPLICATIONS; DEPRESSION;

D O I：

10.1177/2048872619853579

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

Background: Recent advances in digital electrocardiography technology allow evaluating ST-segment deviations in all 12 leads as quantitative variables and calculating summed ST-segment deviation scores. The diagnostic and prognostic utility of summed ST-segment deviation scores is largely unknown. Methods: We aimed to explore the diagnostic and prognostic utility of the conventional and the modified ST-segment deviation score (Better Analysis of ST-segment Elevations and Depressions in a 12- Lead-ECG-Score (BASEL-Score): sum of elevations in the augmented voltage right - lead (aVR) plus absolute, unsigned ST-segment depressions in the remaining leads) in patients presenting with suspected non-ST-segment elevation myocardial infarction. The diagnostic endpoint was non-ST-segment elevation myocardial infarction, adjudicated by two independent cardiologists. Prognostic endpoint was mortality during two-year follow up. Results: Among 1330 patients, non-ST-segment elevation myocardial infarction was present in 200 (15%) patients. Diagnostic accuracy for non-ST-segment elevation myocardial infarction as quantified by the area under the receiver-operating-characteristics curve was significantly higher for the BASEL-Score (0.73; 95% confidence interval 0.69-0.77) as compared to the conventional ST-segment deviation score (0.53; 95% confidence interval 0.49-0.57, p<0.001). The BASEL-Score provided additional independent diagnostic value to dichotomous electrocardiogram variables (ST-segment depression, T-inversion, both p<0.001) and to high-sensitivity cardiac troponin (p<0.001) as well as clinical judgment at 90 min (p<0.001). Similarly, only the BASEL-Score proved to be an independent predictor of two year mortality. Conclusions: The modified ST-segment deviation score BASEL-Score focusing on ST-segment elevation in aVR and ST-segment depressions in the remaining leads provides incremental diagnostic and prognostic information.

引用

页码：857 / 868

页数：12

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