心电图对陈旧性心肌梗死的诊断价值及漏诊原因分析

Diagnostic Values of Vectorcardiogram for Old Myocardial Infarctions and Causes of Missed Diagnosis

目的评价心电图对陈旧性心肌梗死的诊断价值,分析漏诊原因。方法入选陈旧性心肌梗死患者72例,非心肌梗死患者32例作为对照组,顺序记录12导心电图,计算心电图诊断陈旧性心肌梗死的敏感性、特异性和准确性;并比较心电图诊断正确组和漏诊组患者的性别、年龄、心肌梗死部位和冠状动脉病变支数的差异。结果心电图对陈旧性心肌梗死的诊断敏感性、准确性、特异性分别为48.61%、61.54%和90.63%;心电图诊断正确组和漏诊组患者的性别、年龄和心肌梗死部位比较,差异无统计学意义(P>0.05);心电图诊断正确组和漏诊组患者的冠状动脉病变支数间差异有统计学意义(P<0.05)。结论心电图诊断陈旧性心肌梗死具有较高特异性,但敏感性和准确性低,容易漏诊,漏诊原因主要与冠状动脉三支病变有关,与心肌梗死部位、性别关系不明显。

Objective To evaluate the diagnostic values of electrocardiogram for old myocardial infarctions and to analyze the causes of missed diagnosis.Methods A total of 72 patients with old myocardial infarctions and 32 non-myocardial infarction patients（as controls） were enrolled with 12 lead electrocardiogram（ECG） recorded and sensitivity,specificity and accuracy for diagnosing old myocardial infarction calculated.Comparison of gender,age,the site of myocardial infarction and the number of coronary artery lesions between the correctly-diagnosed group and the misdiagnosed group were made.Results The sensitivity,accuracy and specificity of electrocardiogram in diagnosing old myocardial infarction were 48.61%,61.54% and 90.63%,respectively;Gender,age and the site of myocardial infarction showed no statistically significant differences（P0.05）,while the numbers of coronary artery lesions were significantly different between the correctly-diagnosed and the misdiagnosed group（P0.05）.Conclusion With high specificity but relatively low sensitivity and accuracy,the rate of missed diagnosis of ECG in diagnosing old myocardial infarctions is high,which is mainly associated with lesions in three branch coronary arteries.