| background:With the impact of lifestyle changes and aging of the population,the incidence of cardiovascular diseases in China has been increasing year by year,and has become one of the leading causes of death among residents.Data show that the total number of people suffering from cardiovascular diseases in China is up to 290 million,and acute ST-segment elevation myocardial infarction(STEMI)is the most serious type of them.In case of sudden STEMI,emergency treatment,early diagnosis and emergency revascularization can significantly reduce the mortality rate and disability rate of myocardial infarction.Direct percutaneous coronary intervention(PPCI)is the preferred reperfusion strategy for patients with STEMI,and the time interval from symptom onset to reperfusion is a key factor in determining the clinical outcome of the treatment.Rapid diagnosis of acute STEMI is of great importance for shortening the reperfusion time of patients.Routine 12-lead electrocardiogram(ECG)is the most commonly used method for diagnosis of STEMI,and relevant guidelines at home and abroad recommend that 12-lead electrocardiogram should be performed routinely and as early as possible for patients with suspected myocardial infarction.All patients with suspected STEMI(chest pain)are advised to use the Emergency Medical Service(EMS)as soon as possible.With the rapid development of emergency medicine,major cities has established a perfect first aid network system,which the urban patients accounted for 25%of the total benefit,while the rural patients accounted for 75%benefit less.Statistics show that emergency medical services(EMS)application proportion in China was only about 15%,first medical contact time of more than half of patients with STEMI more than 6 hours.For Chinese patients,especially rural patients,shorten the visit time of suspected STEMI patients is very important.Objective:The aim of this study was to optimize the procedure of electrocardiogram(ECG)diagnosis for patients with acute ST-segment elevation myocardial infarction(STEMI),and to explore a sensitive,convenient and rapid method for the diagnosis of STEMI.Methods:The clinical data of 355 patients with acute coronary syndrome(ACS)who were admitted to our hospital from November 2019 to July 2020 were retrospectively analyzed.Using standard 12-lead ECG as the gold standard,the sensitivity,specificity and accuracy of STEMI diagnosis combined with 2-3 key lead ECG were evaluatedResult:1.In patients with acute inferior myocardial infarction,the diagnostic sensitivity of single lead Ⅱ,Ⅲ and AVF was 94.3%,100%and 94.3%,respectively,and the difference was not statistically significant(P>0.05).:In patients with acute inferior myocardial infarction,the diagnostic sensitivity of single lead Ⅱ,Ⅲ and AVF was 94.3%,100%and 94.3%,respectively,and the difference was not statistically significant(P>0.05).In patients with non-inferior wall myocardial infarction,the diagnostic sensitivity of V2,V3 and V4 single leads was 82.1%,89.7%and 83.3%,respectively,showing no statistical difference(P>0.05),which was superior to leads,AVR,AVL,V1,V5 and V6(P<0.05).2.In all ACS patients,the sensitivity,specificity and accuracy of the combination of two leads(Ⅱ/Ⅲ/AVF+V2/V3/V4)in STEMI diagnosis ranged from 88.5%-93.9%,90.6%to 96.4%,and 89.9%-92.6%,among which the V3+Ⅲ lead combination had the highest sensitivity of 93.9%.On the basis of the combination of V3+Ⅲ double lead,furtherly increasing lead to three.The highest sensitivity can be increased to 96.2(V3+Ⅲ+Ⅰ,V3+Ⅲ+V5,V3+Ⅲ+V6).But compared with V3+Ⅲ,there was no statistically significant difference(P>0.05).The specificity and accuracy of V3+Ⅲ+V6 combination are(94.2%,94.9%)slightly higher than the V3+Ⅲ+Ⅰ or V3+Ⅲ+V5 combination(92.9%,94.1%and 92.4%,93.8%),There was no statistically significant difference(P>0.05)Conclusions:In patients with ACS,electrocardiogram combined with 2-3 key leads can diagnose acute STEMI conveniently and quickly,with good sensitivity,specificity and accuracy,and has certain clinical application value. |
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