Systematic review and meta-analysis of diagnostic test accuracy of ST-segment elevation for acute coronary occlusion.

Autor: de Alencar Neto JN; Cardiology, Instituto Dante Pazzanese de Cardiologia, São Paulo, Brazil. Electronic address: jose.alencar@dantepazzanese.org.br., Scheffer MK; Cardiology, Instituto Dante Pazzanese de Cardiologia, São Paulo, Brazil., Correia BP; Cardiology, Instituto Dante Pazzanese de Cardiologia, São Paulo, Brazil., Franchini KG; Cardiology, Instituto Dante Pazzanese de Cardiologia, São Paulo, Brazil., Felicioni SP; Cardiology, Instituto Dante Pazzanese de Cardiologia, São Paulo, Brazil., De Marchi MFN; Cardiology, Instituto Dante Pazzanese de Cardiologia, São Paulo, Brazil.
Jazyk: angličtina
Zdroj: International journal of cardiology [Int J Cardiol] 2024 May 01; Vol. 402, pp. 131889. Date of Electronic Publication: 2024 Feb 20.
DOI: 10.1016/j.ijcard.2024.131889
Abstrakt: Objective: To evaluate the diagnostic sensitivity and specificity of ST-segment elevation on a 12‑lead ECG in detecting ACO across any coronary artery, challenging the current STEMI-NSTEMI paradigm.
Methods: Studies from MEDLINE and Scopus (2012-2023) comparing ECG findings with coronary angiograms were systematically reviewed and analyzed following PRISMA-DTA guidelines. QUADAS-2 assessed the risk of bias.
Study Selection: Studies included focused on AMI patients and provided data enabling the construction of contingency tables for sensitivity and specificity calculation, excluding those with non-ACS conditions, outdated STEMI criteria, or a specific focus on bundle branch blocks or other complex diagnoses. Data were extracted systematically and pooled test accuracy estimates were computed using MetaDTA software, employing bivariate analyses for within- and between-study variation. The primary outcomes measured were the sensitivity and specificity of ST-segment elevation in detecting ACO.
Results: Three studies with 23,704 participants were included. The pooled sensitivity of ST-segment elevation for detecting ACO was 43.6% (95% CI: 34.7%-52.9%), indicating that over half of ACO cases may not exhibit ST-segment elevation. The specificity was 96.5% (95% CI: 91.2%-98.7%). Additional analysis using the OMI-NOMI strategy showed improved sensitivity (78.1%, 95% CI: 62.7%-88.3%) while maintaining similar specificity (94.4%, 95% CI: 88.6%-97.3%).
Conclusion: The findings reveal a significant diagnostic gap in the current STEMI-NSTEMI paradigm, with over half of ACO cases potentially lacking ST-segment elevation. The OMI-NOMI strategy could offer an improved diagnostic approach. The high heterogeneity and limited number of studies necessitate cautious interpretation and further research in diverse settings.
Competing Interests: Declaration of competing interest There is no conflict of interest to disclose.
(Copyright © 2024 Elsevier B.V. All rights reserved.)
Databáze: MEDLINE
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