416例胸痛患者冠脉造影的回顾分析

Retrospective Analysis of Coronary Angiography in 416 Cases with Chest Pain

目的:探讨患者临床表现、心电图改变对冠心病的诊断意义。材料与方法:选取416例冠脉造影病例,临床表现和心电图改变分成2组,行常规12导联ECG检查,并加做V3R、V4R、V5R导联及冠脉造影,进行患者临床表现心电图及冠脉造影比较。结果:典型胸痛诊断冠心病灵敏度为42.4%、特异度为64.7%,阳性预测值为82.2%,阴性预测值为58.3%,心肌缺血的心电图在诊断冠心病的灵敏度为64.6%、特异度为36.7%、阳性预测值为47.0%、阴性预测值为54.7%。心肌缺血的心电图在ST段压低或抬高诊断冠心病的灵敏度为53.1%、特异度为67.2%、阳性预测值为66.1%、阴性预测值为54.3%。心肌制备的心电图中T波倒置诊断冠心病的灵敏度为40.0%、特异度为44.8%、阳性预测值为31.63%、阴性预测值为54.63%。心肌制备的心电图在典型胸痛诊断冠心病灵敏度为70.3%、特异度为40.5%,阳性预测为58.7%、阴性预测值为53.3%。心肌缺血的心电图在不典型胸痛诊断冠心病的灵敏度为61.5%、特异度为34.5%、阳性预测值为40.2%、阴性预测值为55.6%。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;心肌缺血的心电图诊断冠心病的敏感性高而特异性低,单凭其诊断冠心病有一定的片面性;与临床和其他实验室资料相联系,ST段、T波改变具有较大的预测价值。ST段压低或抬高在诊断冠心病中的价值要优于单纯T波改变者。

Purpose： To Study the value of clinical manifestation and change of electrocardiogram （ECG） in diagnosis of coronary artery disease （CAD）. Materials and Methods： 416 cases performed coronary angiegraphy （CAG） were enrolled. Aecording to clinical manifestatian and change of electrocardiograrm （ECG）, they were divided into two groups, every patient received twelve normal leads electriceardiography, and V3R, V4R, VSR leads. Compare clinical manifestation and change of electrocardiograrm （ECG） with coronary angiography. Restills： Sensitivity which diagnosis coronary heart disease in angina pectoris group is 42.2%, specificity is 64.7%, positive predictive value is 82.2%, negative predictive value is 58.3%, myocardial isehemic （ECG） diagnosis coronary heart disease sensitivity is 64.6%, specificity is 36.7%, positive predictive value is 47.0%, negative predictive value is 54.7%, ST segment depression or raise of myocardial isehemic （ECG） diagnosis coronary heart disease sensitivity is 53..1%, specificity is 67.2%, positive predictive value is 66.1%, negative predictive value is 54.3%, myocardial isehemic （ECG） which diagnosis coronary heart disease in angina pectoris group sensitivity is 70.3%, specificity is 40.5%, positive predictive value is 58.7%, negative predictive value is 53.3%, myocardial isehemic （ECG） which diagnosis coronary heart disease in atypical chest pain group sensitivity is 61.5%, specificity is 34.5%, positive predictive value is 40.2%, negative predictive value os 55.6%. Conclusion： 1. angina pectoris diagnosis coronary heart disease specificity is big, positive predictive value is big, misdiagnosis rate is low, angina pectoris have coronary heart disease possibility is great, myocardial ischemic （ECG） diagnosis coronary heart disease sensitivity is great, specificity is low, negative rpedictive value is better, if-diagnosis coronary heart.disease with this alone, it will be one - sidedness, The value which diagngosis coronary heart disease with ST segment depression or raise is better than single T wave change, assiociated with other clinical or lab check, predictive value of ST segment and T wave will be better.