Objective. To assess the clinical utility of synthesized V7–V9 ST-segment elevation (sV7-9 STE) in patients with 12-lead-electrocardiogram (ECG)-based non-STE myocardial infarction (NSTEMI) in diagnosing left circumflex artery (LCx) STEMI-equivalent acute coronary syndrome (ACS). Background. The 12-lead-ECG is insufficient for diagnosing patients with ACS, especially those with an LCx culprit. Methods. We retrospectively examined 219 patients with NSTEMI who underwent synthesized 18-lead ECG acquisition on admission and urgent catheterization. Associations between baseline variables, including sV7-9 STE and LCx STEMI-equivalent ACS, were analyzed using logistic regression models and receiver operating characteristics. LCx-culprit ACS was defined as thrombolysis in myocardial infarction (TIMI) 0–1 flow. The association between sV7-9 STE and myocardial damage was also assessed. Results. The mean (SD) age of the population was 68.8 (12.0) years, and 81.7% were men. LCx-culprit NSTEMI occurred in 58 (26.5%) patients and 15 (6.8%) were LCx STEMI-equivalent. SV7-9 STE was observed in 16 patients (7.9%). SV7-9 STE was the sole significant predictor of LCx STEMI-equivalent ACS with an odds ratio of 19.0 (95% CI: 5.6–63.9, ), area under the curve of 0.71 (95% CI: 0.58–0.84), sensitivity of 46.7%, and specificity of 95.6%. After adjustment for confounders, sV7-9 STE was significantly associated with a 308% (95% CI: 78–834%) increase in peak high-sensitivity cardiac troponin I (). Conclusions. SV7-9 STE had sole preprocedural diagnostic utility in detecting LCx STEMI-equivalent ACS with greater myocardial damage among patients with 12 ECG-based NSTEMI. The use of synthesized extra leads on admission may help identify patients with NSTEMI requiring primary revascularization.

中文翻译：

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综合 18 导联心电图诊断 NSTEMI 患者的后胸后等效急性冠脉综合征

客观。评估综合 V7-V9 ST 段抬高 (sV7-9 STE) 在基于 12 导联心电图 (ECG) 的非 STE 心肌梗死 (NSTEMI) 患者诊断左回旋支 (LCx) STEMI 中的临床效用-等效的急性冠状动脉综合征（ACS）。背景。12 导联心电图不足以诊断 ACS 患者，尤其是那些有 LCx 罪魁祸首的患者。方法. 我们回顾性检查了 219 名 NSTEMI 患者，他们在入院时接受了合成 18 导联心电图采集和紧急导管插入术。使用逻辑回归模型和接受者操作特征分析基线变量之间的关联，包括 sV7-9 STE 和 LCx STEMI 等效 ACS。LCx-罪魁祸首 ACS 被定义为心肌梗死 (TIMI) 0-1 流量中的溶栓。还评估了 sV7-9 STE 与心肌损伤之间的关联。结果. 人口的平均 (SD) 年龄为 68.8 (12.0) 岁，81.7% 为男性。LCx 罪魁祸首 NSTEMI 发生在 58 名 (26.5%) 患者中，15 名 (6.8%) 是 LCx STEMI 等效的。在 16 名患者 (7.9%) 中观察到 SV7-9 STE。SV7-9 STE 是 LCx STEMI 等效 ACS 的唯一显着预测因子，优势比为 19.0（95% CI：5.6-63.9，)，曲线下面积为 0.71（95% CI：0.58-0.84），灵敏度为 46.7%，特异性为 95.6%。调整混杂因素后，sV7-9 STE 与高敏心肌肌钙蛋白 I 峰值增加 308%（95% CI：78-834%）显着相关（）。 结论。SV7-9 STE 在检测 12 例基于 ECG 的 NSTEMI 患者中具有更大心肌损伤的 LCx STEMI 等效 ACS 方面具有唯一的术前诊断效用。入院时使用合成的额外导联可能有助于识别需要初次血运重建的 NSTEMI 患者。