ABSTRACT
OBJETIVO: Avaliar a sensibilidade diagnóstica e a especificidade do supradesnivelamento do segmento ST em um ECG de 12 derivações na detecção de oclusão coronária aguda em qualquer artéria coronariana, desafiando o atual paradigma IAMCSST-IAMSSST. MÉTODOS: Estudos do MEDLINE e Scopus (2012-2023) comparando achados de ECG com angiogramas coronários foram revisados e analisados sistematicamente seguindo as diretrizes PRISMA-DTA. O risco de viés foi avaliado pelo QUADAS-2. SELEÇÃO DE ESTUDOS: Os estudos incluídos focaram em pacientes com síndrome coronária aguda e forneceram dados que permitiram a construção de tabelas de contingência para cálculo de sensibilidade e especificidade, excluindo aqueles com condições não-SCA, critérios desatualizados de STEMI ou foco específico em bloqueios de ramo ou artérias coronárias específicas. Os dados foram extraídos sistematicamente e as estimativas de precisão dos testes agrupadas foram calculadas usando o software MetaDTA, empregando análises bivariadas para variação intra e inter-estudos. Os desfechos primários medidos foram a sensibilidade e especificidade do supradesnivelamento do segmento ST na detecção de OCA. RESULTADOS: Três estudos com 23704 participantes foram incluídos. A sensibilidade agrupada do supradesnivelamento do segmento ST para detecção de OCA foi de 43,6% (IC 95%: 34,7%-52,9%), indicando que mais da metade dos casos de OCA pode não apresentar critérios de supradesnivelamento do segmento ST. A especificidade foi de 96,5% (IC 95%: 91,2%-98,7%). Uma análise adicional usando a estratégia OMI-NOMI mostrou sensibilidade melhorada (78,1%, IC 95%: 62,7%-88,3%) mantendo especificidade semelhante (94,4%, IC 95%: 88,6%-97,3%). CONCLUSÃO: Os achados revelam uma lacuna diagnóstica significativa no atual paradigma IAMCSST-IAMSSST, com mais da metade dos casos de OCA potencialmente ausentes de supradesnivelamento do segmento ST. A estratégia OMI-NOMI poderia oferecer uma abordagem diagnóstica aprimorada. A alta heterogeneidade e o número limitado de estudos exigem interpretação cautelosa e mais pesquisas em ambientes diversos.
ABSTRACT
OBJECTIVE: To evaluate the diagnostic sensitivity and specificity of ST-segment elevation on a 12lead 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.
Subject(s)
Coronary Occlusion , Electrocardiography , ST Elevation Myocardial Infarction , Humans , Electrocardiography/methods , ST Elevation Myocardial Infarction/diagnosis , Coronary Occlusion/diagnosis , Coronary Occlusion/diagnostic imaging , Reproducibility of Results , Coronary Angiography/methodsABSTRACT
OBJECTIVE: To evaluate the diagnostic sensitivity and specificity of ST-segment elevation on a 12lead 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 criteria. 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.