מתוך medicontext.co.il
By David Douglas
WESTPORT, CT (Reuters Health) – A non-concave elevation of the electrocardiographic ST segment appears indicative of acute myocardial infarction (AMI) in chest pain patients seeking emergency department treatment, according to researchers at the University of Virginia School of Medicine in Charlottesville.
"If one considers the differential diagnosis of electrocardiographic ST segment elevation in adult chest pain patients in the ED," Dr. William J. Brady told Reuters Health, "a number of syndromes are possible–AMI as well as other, non-infarction entities. If the physician is to make the appropriate diagnosis and offer therapy for such patients, the ECG must be interpreted in correct fashion."
In order to assess the utility of ST-segment morphologic analysis in AMI diagnosis, Dr. Brady and colleagues examined findings in 599 chest pain patients. The results appeared in the October issue of Academic Emergency Medicine.
Altogether, 171 subjects had elevated ST segments on their electrocardiograms. In this group, 56 had AMI, 50 had unstable angina pectoris and 65 had non-coronary final diagnoses.
In total, 49 patients showed non-concave ST elevations, and 46 of them had AMI. The sensitivity of such morphology for AMI diagnosis was 77% and the specificity was 99%. The positive predictive value was 94% and the negative predicative value was 88%.
"The concave morphology is associated with non-AMI causes of ST segment elevation," Dr. Brady explained. However, he cautioned, "like any clinical interpretive tool, this approach is fallible–diagnostic and treatment decisions must be made with this caveat in mind."
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