心電図は,左括約筋支部のブロックと心筋梗塞の疑いのある患者の治療をガイドするために使用されるべきですか?
M G Shlipak1, W L Lyons, A S Go
1Veterans Affairs Medical Center, Department of Medicine, University of California, San Francisco 94121, USA.
JAMA
|March 3, 1999
まとめ
電気心臓図 (ECG) アルゴリズムは,左束支部ブロック (LBBB) の患者の心筋梗塞 (MI) を信頼性のある方法で予測することはできません. 血栓解消剤の治療は,MIを示唆する症状を有するすべてのLBBB患者に対して検討されるべきである.
科学分野:
- 心臓病学 心臓病学
- 緊急医療 緊急医療
- 診断アルゴリズム
背景:
- 左束枝ブロック (LBBB) の患者の心筋梗塞 (MI) を予測するために,心電図 (ECG) アルゴリズムが開発されました.
- このEKGアルゴリズムの臨床的影響と診断的有用性は,依然としてほとんど不明です.
研究 の 目的:
- LBBB患者におけるMIのためのECGアルゴリズムの診断テスト特性を評価する.
- 疑わしい心筋梗塞の治療決定を導くために,EKGアルゴリズムの臨床的有用性を評価する.
主な方法:
- LBBBとMIを示唆する症状を持つ患者を対象とした遡及的なコホート研究.
- 特定のECGアルゴリズムを適用して,MIを予測する.
- アルゴリズムによって導かれた血栓溶解と標準治療を比較した意思決定分析.
主要な成果:
- ECGアルゴリズムは,心筋梗塞を特定する際に,低感度 (10%) を示した.
- 評価されたECGの発見はどれも,このコホートにおける他の診断からMIを効果的に区別しなかった.
- 決定分析は,胸痛のLBBB患者に対する普遍的血栓解離が,スクリーニングツールとしてECGアルゴリズムを使用すると比較して,より良い生存結果をもたらしたことを示しました.
結論:
- ECGアルゴリズムは,急性心肺症状を呈するLBBB患者におけるMIの信頼性の低い予測指標である.
- 急性血栓駆除薬の治療は,LBBBのすべての患者で,MIに一致する症状を経験するすべての患者に強く考慮されるべきです.
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