冠状动脉血管成像检查联合动态心电图对ST段抬高型心肌梗死罪犯血管的诊断价值

The diagnostic value of culprit blood vessels of CTA combined with Holter in acute ST segment elevation myocardial infarction

目的探讨冠状动脉血管成像(CTA)联合动态心电图(DCG)对于ST段抬高型心肌梗死罪犯血管定位中的诊断价值。方法回顾性分析德阳市人民医院2017年1月至2019年12月经常规心电图示ST段抬高型心肌梗死且存在DCG、冠状动脉CTA及冠状动脉造影(CAG)检查的患者194例,以CAG定位罪犯血管为金标准,评估冠状动脉CTA、DCG及其联合应用检查对ST段抬高型心肌梗死罪犯血管定位中的诊断价值。结果最终经CAG确诊ST段抬高型心肌梗死者179例;冠状动脉CTA联合DCG定位左前降支、左回旋支、右冠状动脉罪犯血管的平均准确性(90.20%)明显高于单独应用DCG(68.98%)或冠状动脉CTA(80.41%)的平均准确性(P<0.05);冠状动脉CTA联合DCG对于ST段抬高型心肌梗死罪犯血管定位诊断灵敏度、特异度、准确度、阳性预测值、阴性预测值分别为94.41%、77.78%、90.72%、98.83%和41.18%,均明显高于单独应用DCG或冠状动脉CTA检查(P<0.05)。结论冠状动脉CTA检查联合DCG对ST段抬高型心肌梗死定位罪犯血管诊断优势明显优于单独应用DCG或冠状动脉CTA检查。

Objective To explore the diagnostic value of coronary angiography(CTA)combined with dynamic electrocardiogram(DCG)in locating the culprit vessels of ST segment elevation myocardial infarction(STEMI).Methods A retrospective analysis was performed on 194 patients with ST segment elevation myocardial infarction from January 21,2017 to December 31,2019in Deyang People's Hospital.The patients all had the data of DCG,CTA,and coronary angiography(CAG).Using CAG to locate culprit's blood vessels as the gold standard,we evaluated the diagnostic value of CTA and DCG and their combined application inlocatingculprit's blood vessels in patients with STEMI.Results Finally,179 patients with STEMI were diagnosed by CAG.The average accuracy of CTA combined with DCG in locating the culprit vessels of left anterior descending(LAD)artery,left circumflex(LCX)arteryand right coronary artery(RCA)was 90.20%which was significantly higher than DCG alone(68.98%)or CTA alone(80.41%)(P<0.05).The diagnostic sensitivity,specificity,accuracy,positive predictive value,and negative predictive value of CTA combined with DCG in locating the culprit vessels in patients with STEMI were 94.41%,77.78%,90.72%,98.83%,and 41.18%,respectively.These all were significantly higher than those of DCG or CTA alone(P<0.05).Conclusion The advantage of CTA combined with DCG in the diagnosis of culprit vessels in STEMI is better than DCG or CTA alone.