Meta-Analysis of Dynamic Electrocardiography in the Diagnosis of Myocardial Ischemic Attack of Coronary Heart Disease

Abstract

Background and Aims. Patients with coronary artery disease (CHD) are prone to early myocardial ischemia; early diagnosis of myocardial ischemia is of great significance in judging disease progression and guiding clinical intervention. However, reports on the accuracy of dynamic electrocardiogram (ECG) in the diagnosis of myocardial ischemia in patients with CHD are inconsistent. The purpose of the current meta-analysis was to analyze the efficacy of ECG in the diagnosis of myocardial ischemia attack in CHD. Methods. Chinese database (Wanfang, VIP, and CNKI) and English database (PubMed, Web of Science, Embase, SinoMed, and Cochrane Library) were searched. A study on the collection of dynamic ECG in the diagnosis of myocardial ischemic attack of coronary heart disease to extract data and calculate sensitivity (Sen), specificity (Spe), positive likelihood ratio (+LR), negative likelihood ratio (- LR), and diagnostic odds ratio (DOR). Draw summary receiver operating characteristic curves (SROC), and calculate area under curve (AUC). Stata 15 software was used for meta-analysis. Results. Twenty-seven literatures were included in this study. Meta-analysis results showed that $\text{Sen}=0.78$ (95% CI: 0.73~0.82), $\text{Spe}=0.76$ (95% CI: 0.68~0.82), $+\text{LR}=2.79$ (95% CI: 2.17~3.59), $-\text{LR}=0.33$ (95% CI: 0.27~0.40), $\text{AUC}=0.84$ (95% CI: 0.80~0.87), and $\text{DOR}=9.66$ (95% CI: 6.13~15.21). Subgroup analysis showed that the sensitivity of 12-lead ECG was higher than that of 3-lead ECG. The sensitivity and specificity of ST segment and QTc interphase changes were higher than those of ST segment changes alone ( $P<0.05$ ). Conclusion. Dynamic ECG has high application value in the diagnosis of myocardial ischemia attack of coronary heart disease. But it is difficult to achieve a satisfactory level of use alone. ST segment combined with QTc interval observation can improve the diagnostic accuracy. Synchronous observation of ST segment and QTc interval can improve the diagnostic efficiency.