يافته هاي الكتروكارديوگرافي مرتبط با ايسكمي ميوكارد در بيماران با علايم غير قلبي مراجعه كننده به اورژانس نمازي در سال 1397

Abstract

Introduction: Silent myocardial ischemia is defined as the presence of objective evidence of cardiac ischemia in the absence of chest discomfort or one of the symptoms equivalent to angina. The aim of this study was to evaluate the electrocardiography (ECG) findings related to cardiac ischemia in non-cardiac patients with suspected silent myocardial ischemia referring to the emergency department. Methods: This retrospective cross-sectional study (March 2018-March 2019) was conducted on adult patients with non-cardiac complaints referring to the Emergency Department of Shiraz Namazi Hospital, southern Iran, with triage levels 1 and 2, who were suspected to have silent myocardial ischemia, and underwent ECG and two troponin tests after admission. Patients with trauma, triage levels 3-5, those with typical chest pain, and patients with diagnosis of ST-Elevation Myocardial Infarction (STEMI) were excluded from the survey. Demographic data, the results of two troponin tests, and cardiac ischemia-related findings on ECG, including ST depression and T inversion, were evaluated. Then, the data were statistically analyzed using SPSS version 16 and descriptive and analytical statistical tests. Results: Overall, 180 patients were enrolled. The mean (± standard deviation) of patients’ age was 69.3±15.01 years. 92 patients (51.1%) were male. ST depression and T inversion were found in ECG of 90 (50.0%) and 88 (48.9%) patients, respectively. ST depression and/or T inversion was observed in 168 (93.3%) patients. There was no statistically significant relationship between mean age, gender, and cause of referral with ST depression or T inversion. Two positive troponin test results were observed in 23 (12.8%) and both tests were negative in 59.4% of patients. There was no statistically significant relationship between having at least one positive troponin test and having ST depression or T inversion findings (P-value=0.56 and P-value=0.90, respectively). Conclusion: ST depression and T inversion were present in ECG of half of the patients. Two positive troponin and both negative tests were observed in 23 (12.8%) and 59.4% of patients, respectively. This finding indicates that the matching of ECG findings and multistage troponin test is great important in the final diagnosis of cardiac ischemia, however, ECG changes in patients with non-cardiac complaints do not necessarily is indicated the myocardial infarction.