| Object:To observe the correlation of ECG ST segment and MDCT coronary angiography (MDCTCA) in the diagnosis of coronary heart disease (CHD). Methods: Retrospectively analyzed300patients were performed64row spiral CT coronary artery imaging and conventional ECG in our hospital, all of them were suspected CHD. On the basis of the result of MDCTCA, considered the stenosis of at least one coronary artery was more than50%to be CHD. ECG ST segment positive change160cases,140negative cases; according the result of MSCTCA, there were220cases that conformed to the diagnostic criteria of CHD,21cases were normal and59cases’ coronary artery stenosis were less than50%. Then compared the statistical differences of two methods in diagnosing coronary heart disease with chi-square. According to different extent of coronary artery stenosis, all patients were divided into normal or mild stenosis group(<50%), moderate stenosis group (50-74%), severe stenosis group (75%or higher), to analyze if there was statistical difference among each group on the correlation with ECG ST segment change. According to the results of MDCTCA, patients were divided into single coronary artery atherosclerosis group and more than one coronary artery atherosclerosis group, the two group were divided into CHD group and non-CHD group respectively. To analyze if there was statistical difference between single coronary artery lesions of CHD and multi-coronary lesions of CHD on the correlation with ECG ST segment change, to observe if there was statistical difference between CHD group and non-CHD group in single artery atherosclerosis group, and if there was statistical difference between CHD group and non-CHD group in more than one coronary artery atherosclerosis group. In50patients with ST segment elevation, to analyze if there was statistical difference between single artery atherosclerosis and multi-coronary artery atherosclerosis on conforming to the standard of coronary artery stenosis of CHD, In110patients with ST segment down, to analyze if there was statistical difference between single artery atherosclerosis with multi-coronary artery atherosclerosis on conforming to the standard of coronary artery stenosis of CHD. I, avL, VI-5ST segment changes usually indicate left coronary artery and (or) its branches lesions which caused ischemia or injury, Ⅱ, Ⅲ, avF ST segment changes usually indicate the right coronary artery and its branches lesions which caused ischemia or injury.26patients were involved in I, avL, V1-V5ST segment elevation,82patients were involved in I, avL, V1-V5ST segment down,24patients were involved in Ⅱ, Ⅲ, avF ST segment elevation,28patients were involved in Ⅱ, Ⅲ, avF ST segment down. Defined artery stenosis of at least one coronary as CHD group, whereas for the non-CHD group, and with chi-square test for statistical analysis. Results:The sensitivity, specific degree, positive predictive value, negative predictive value and accuracy were58.1%,60.0%,80%,35%,58.7%respectively for conventional ECG to predict CHD, it has significant differences for two methods in diagnosing CHD (P<0.01);ST segment change positive rate was33.8%in Normal coronary or mild stenosis group, they were37.7%,93.3%respectively in moderate and severe stenosis group,the correlations between coronary artery narrow groups with different level and ECG ST segment change existed obvious difference (P<0.01), the correlation between coronary artery narrow50-74%and ST segment change, the correlation between coronary artery narrow≥75%and ST segment change, analyze the correlations above, they have statistical difference (P<0.01), the correlation between coronary artery stenosis<50%and ST segment change, the correlation between coronary artery stenosis≥75%and ST segment change, analyze the correlations above, they have significant statistical difference (P<0.01). However, correlations between coronary artery stenosis<50%with ST segment change and coronary artery narrow50-74%with ST segment change, there was no statistical difference (P>0.05);The positive predictive value of ST segment change were51.8%and65.7%respectively in single coronary artery lesion group and multivessel disease of CHD, correlations between single coronary artery lesion with ST segment change and multi-coronary artery lesions with ST segment change has statistical difference (P<0.05), correlations between single coronary artery lesion of CHD with ST segment change and single coronary artery lesions of non-CHD with ST segment change has no statistical difference (P>0.05), correlations between multi-coronary artery lesion of CHD with ST segment change and multi-coronary artery lesions of non-CHD with ST segment change has statistical difference (P<0.05); In ST segment elevation,42.9%of single coronary artery lesions was up to the standard of CHD,70%of multi-coronary lesions was up to the standard of CHD, In ST segment down,62.5%of was up to the standard of CHD,62.8%of multi-coronary lesions was up to the standard of CHD, In patients with ST segment elevation, there was statistical difference(P<0.05) between single artery atherosclerosis and multi-coronary artery atherosclerosis on conforming to the standard of coronary artery stenosis of CHD, In patients with ST segment down, there was statistical no statistical difference (P>0.05) between single artery atherosclerosis with multi-coronary artery atherosclerosis on conforming to the standard of coronary artery stenosis of CHD. The positive rate of I, avL and V1-V5ST segment elevation to predict coronary artery stenosis up to the standard of CHD was84%, the positive rate of Ⅱ, Ⅲ and avF ST segment elevation to predict coronary artery stenosis up to the standard of CHD was37.5%, the positive rate of I, avL and V1-V5ST segment down to predict coronary artery stenosis up to the standard of CHD was65.9%, the positive rate of Ⅱ, Ⅲ and avF ST segment down to predict coronary artery stenosis up to the standard of CHD was53.6%, in patients with ST segment elevation, there was statistical difference (P<0.05) between ST segment located in left coronary artery or its branch lesions and ST segment located in right coronary artery or its branch lesions, in patients with ST segment down, there was statistical no statistical difference (P>0.05) between ST segment located in left coronary artery or its branch lesions and ST segment located in right coronary artery or its branch lesions. Conclusions:1There has been a difference between normal resting ECG ST segment change and MDCTCA in diagnosing CHD, it need to be careful before make the diagnosis of CHD only with ECG ST segment change.2In different degree of coronary artery stenosis, ECG ST segment change in predicting severe coronary artery stenosis of CHD has the most clinical value, there was no clinical difference between mild coronary artery stenosis and moderate stenosis for their performance on ECG ST segment change.3. In CHD, multi-coronary lesions was more prone to ST segment change than single lesion, especially ST segment elevation; there was little value in ST segment down for predicting single lesion and multi-coronary lesion.4In predicting CHD, normal resting ECG I/lead avL/V1-5ST segment elevation has more clinical value than Ⅱ/Ⅲ/avF ST elevation prediction. There was little clinical value in ST segment down to predict left coronary artery or its branches lesions and right coronary artery or its branches lesions. |
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