【摘要】 目的 探讨使用三种心电图诊断标准对急诊科拟诊为急性冠脉综合征(ACS)患者合并完全性左束支传导阻滞(CLBBB)时被视为ST段抬高型心肌梗死(STEMI)等危征，最终经急诊冠脉造影证实发生急性心肌梗死的诊断能力。方法 回顾性分析41例在急诊科拟诊为ACS合并CLBBB的患者，均经急诊完善冠脉造影后收入心内科重症监护单元(CCU),最终诊断分为AMI组(n=15)和非AMI组(n=26),分别使用巴塞罗那标准、Sgarbossa标准和Smith标准对两组患者心电图进行评测，绘制各诊断标准受试者工作特征(ROC)曲线，并得出ROC曲线下面积(AUC),分别计算敏感度(SEN)、特异度(SPE)、阳性预测值(PPV)、阴性预测值(NPV)和准确度(CP),并进行解读。结果 巴塞罗那标准对在急诊科拟诊为ACS患者合并CLBBB时，经急诊冠脉造影证实诊断并治疗的AMI的AUC为0.947(P<0.001),其SEN、SPE、PPV、NPV、CP分别为92.9%、92.0%、86.7%、95.8%、92.3%; Sgarbossa≥3标准诊断AMI的AUC为0.647(P=0.120),其SEN、SPE、PPV、NPV、CP分别为35.7%、96.0%、83.3%、72.7%、74.4%;Sgarbossa≥2标准诊断AMI的AUC为0.604(P=0.273),其SEN、SPE、PPV、NPV、CP分别为42.9%、84.0%、60.0%、72.4%、69.2%;SmithⅢ标准诊断AMI的AUC为0.795(P=0.002),其SEN、SPE、PPV、NPV、CP分别为71.4%、92.0%、83.3%、85.2%、84.6%;SmithⅣ标准诊断AMI的AUC为0.656(P=0.099),其SEN、SPE、PPV、NPV、CP分别为50.0%、84.0%、63.6%、75.0%、71.8%;SmithⅤ标准诊断AMI的AUC为0.614(P=0.228),其SEN、SPE、PPV、NPV、CP分别为28.6%、96.0%、80.0%、70.6%、71.8%。巴塞罗那标准对在急诊科拟诊为ACS患者合并CLBBB时经急诊冠脉造影证实，诊断AMI的AUC、SEN、SPE、PPV、NPV、CP均高于Sgarbossa标准和Smith标准(P<0.001)。结论 急诊科拟诊为ACS合并CLBBB的患者中，应用心电图的巴塞罗那标准诊断AMI具有准确、简洁、实用的特点。更多还原

【Abstract】 Objective To investigate the diagnostic ability of three electrocardiographic methods for the patients with acute coronary syndrome(ACS) combined with complete left bundle branch block(CLBBB) in the emergency department when they are considered as ST-segment elevation myocardial infarction(STEMI) risk equivalents and eventually have acute myocardial infarction confirmed by emergency coronary angiography. Methods We retrospectively analyzed 41 patients with a proposed diagnosis of ACS combined with CLBBB in the emergency department. The research subjects were admitted to the CCU after completion of coronary angiography in the emergency department, and were divided into the AMI group(15 cases) and the non-AMI group(26 cases). The electrocardiograms of the two groups were evaluated by using the Barcelona criteria, the Sgarbossa criteria, and the Smith criteria, respectively, and the ROC of each diagnostic method was plotted, the area under the ROC curve(AUC), the sensitivity(SEN), specificity(SPE), positive predictive value(PPV), negative predictive value(NPV), and capability of precision(CP) were calculated. Results The AUC of the Barcelona criteria for the diagnosis of AMI in the patients with ACS combined with CLBBB in the emergency department was 0.947(P<0.001), and its SEN, SPE, PPV, NPV and CP were 92.9%, 92.0%, 86.7%, 95.8%, and 92.3%, respectively. The AUC for diagnosing AMI by Sgarbossa≥3 criteria was 0.647(P=0.120), and its SEN, SPE, PPV, NPV and CP were 35.7%, 96.0%,83.3%,72.7%,74.4%, respectively. The AUC for diagnosing AMI by Sgarbossa≥2 criteria was 0.604(P=0.273), and its SEN, SPE, PPV, NPV, and CP were 42.9%,84.0%,60.0%,72.4%,69.2%, respectively. The AUC for diagnosing AMI by Smith Ⅲ criteria was 0.795(P=0.002), and its SEN, SPE, PPV, NPV and CP were 71.4%,92.0%,83.3%,85.2%,84.6%, respectively. The AUC for diagnosing AMI by Smith Ⅳ criteria was 0.656(P=0.099), and its SEN, SPE, PPV, NPV and CP were 50.0%,84.0%,63.6%,75.0%,71.8%, respectively. The AUC for diagnosing AMI by Smith Ⅴcriteria was 0.614(P=0.228), and its SEN, SPE, PPV, NPV and CP were 28.6%,96.0%,80.0%,70.6%,71.8%, respectively. The Barcelona criteria were higher in AUC, EN, SPE, PPV, NPV and CP than the Sgarbossa and Smith criteria for the diagnosis of AMI in the patients with ACS with CLBBB confirmed by emergency coronary angiography in the emergency department(P<0.001). Conclusions In the patients with ACS combined with CLBBB diagnosed in the emergency department, Barcelona criteria of ECG for the diagnosis of AMI is accurate, concise and practical.更多还原