Diagnostic performance of dynamic electrocardiography in the diagnosis of myocardial ischemic attack in coronary heart disease: a systematic review and meta-analysis

Abstract

Background: Coronary heart disease (CHD) remains a leading cause of mortality worldwide, highlighting the need for early and accurate diagnosis of myocardial ischemia to improve patient outcomes. Dynamic electrocardiography (ECG) has become a critical diagnostic tool due to its capacity for continuous cardiac electrical activity monitoring. However, existing studies show considerable variation in its diagnostic performance. To establish higher-level evidence, this study systematically evaluates the diagnostic accuracy of dynamic ECG for myocardial ischemic episodes in patients with CHD through a comprehensive systematic review and meta-analysis. Methods: A comprehensive literature search was conducted through May 2025 using PubMed, Embase, Web of Science, Cochrane Library, China National Knowledge Infrastructure, and Wanfang databases. Study quality was assessed using the QUADAS-2 instrument. Diagnostic performance was evaluated using sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), diagnostic odds ratio (DOR), and the area under the receiver operating characteristic curve (AUC). Results: The meta-analysis included 24 studies comprising 3,509 participants. The pooled diagnostic performance of dynamic ECG for myocardial ischemia showed a sensitivity of 0.75 (95% CI: 0.70–0.80), specificity of 0.70 (95% CI: 0.64–0.75), PLR of 2.50 (95% CI: 1.99–3.13), NLR of 0.36 (95% CI: 0.28–0.45), DOR of 6.64 (95% CI: 4.55–9.69), and an AUC of 0.79 (95% CI: 0.75–0.82). Subgroup analyses indicated higher diagnostic accuracy in studies involving confirmed CHD cases and those using coronary angiography as the reference standard. Conclusion: Dynamic ECG exhibits moderate diagnostic value for detecting myocardial ischemia in patients with CHD. Its clinical application should be integrated with complementary diagnostic approaches. Further high-quality research is necessary to confirm its diagnostic utility and refine implementation protocols. Systematic review registration: INPLASY202560026.