SERIAL ECGS ARE LESS ACCURATE THAN SERIAL CK-MB RESULTS FOR EMERGENCY DEPARTMENT DIAGNOSIS OF MYOCARDIAL-INFARCTION

被引：81

作者：

HEDGES, JR

YOUNG, GP

HENKEL, GF

GIBLER, WB

GREEN, TR

SWANSON, JR

机构：

[1] Department of Emergency Medicine, Portland Veterans Medical Affairs Center, Portland, OR

[2] Oregon Health Sciences University Portland Veterans Medical Affairs Center, Portland, OR

[3] Emergency Services, Portland Veterans Medical Affairs Center, Portland, OR

[4] Clinical Chemistry Laboratory, Portland Veterans Medical Affairs Center, Portland, OR

[5] Department of Emergency Medicine, University of Cincinnati College of Medicine, Cincinnati, OH

来源：

ANNALS OF EMERGENCY MEDICINE | 1992年 / 21卷 / 12期

关键词：

D O I：

10.1016/S0196-0644(05)80057-5

中图分类号：

R4 [临床医学];

学科分类号：

1002 ; 100602 ;

摘要：

Hypothesis: Serial creatine kinase-MB (CK-MB) levels provide more accurate predictive information regarding myocardial infarction than serial ECGs in emergency department patients with chest discomfort and no ST-segment elevation on the initial ECG. Design: Prospective, observational study. Setting: University hospital and university-affiliated Veterans Affairs Medical Center EDs. Participants: Two hundred sixty-one patients 30 years or older with chest discomfort warranting an ECG and consenting to observation. Exclusions included hemodynamic or rhythm instability and ST-segment elevation of 0.1 mV or more in two or more electrically contiguous leads at presentation. Measurements: ECGs were obtained at presentation and three to four hours after presentation. Significant serial ECG changes sought on comparison of initial and three- to four-hour ECGs were 0.05 mV or more ST elevation or depression, Q-wave development, or T-wave inversion changes in two or more electrically contiguous leads. CK-MB levels were obtained at presentation and hourly for three hours (positive level, 8 or more ng/mL). Myocardial infarction was determined by record review and was based on independent CK-MB measurements. Results: Twenty-eight (11%) patients were diagnosed with a myocardial infarction. Thirty-eight (15%) patients had a serial ECG change. Eleven of the myocardial infarction patients (39%) had a serial ECG change compared with 27 (12%) of the non-myocardial infarction patients (P < .001). Sensitivities and specificities of a serial ECG change versus serial CK-MBs for myocardial infarction were 39% versus 68% (sensitivity) and 88% versus 95% (specificity), respectively. Serial CK-MBs were more accurate than a serial ECG change for predicting myocardial infarction (P < .03). Conclusion: Serial changes in ECGs during a three- to four-hour interval were associated with the diagnosis of myocardial infarction but were infrequent and less accurate than serial CK-MB levels obtained for the same interval.

引用

页码：1445 / 1450

页数：6

共 26 条

[21]

Stark, Vacek, The initial electrocardiogram during admission for myocardial infarction: Use as a predictor of clinical course and facility utilization, Arch Intern Med, 147, pp. 843-846, (1987)

[22]

Slater, Hlartky, Mark, Et al., Outcome in suspected acute myocardial infarction with normal or minimally abnormal electrocardiographic findings, Am J Cardiol, 60, pp. 766-770, (1987)

[23]

Zalenski, Sloan, Chen, Et al., The emergency department ECG and immediately life-threatening complications in initially uncomplicated suspected myocardial ischemia, Ann Emerg Med, 17, pp. 221-226, (1988)

[24]

Fesmire, Percy, Wears, Et al., Risk stratification according to the initial electrocardiogram in patients with suspected acute myocardial infarction, Arch Intern Med, 149, pp. 1294-1297, (1989)

[25]

Lee, Cook, Weisberg, Et al., Acute chest pain in the emergency room: Identification and examination of low-risk patients, Arch Intern Med, 145, pp. 65-69, (1985)

[26]

Rouan, Lee, Cook, Et al., Clinical characteristics and outcome of acute myocardial infarction in patients with initially normal or nonspecific electrocardiograms (A report from the multicenter chest pain study), Am J Cardiol, 64, pp. 1087-1092, (1989)

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