经aVR导联T波形态估测老年STEMI患者冠脉病变程度

Assessment of the degree of coronary artery disease in elderly patients with STEMI by T-wave morphology of aVR lead

目的探讨心电图aVR导联T波形态评估老年ST段抬高型心肌梗死(STEMI)患者冠脉病变程度的临床应用效果及价值。方法回顾性分析2020年7月至2022年7月本院收治的140例老年STEMI患者的临床病例资料,并根据患者入院心电图aVR导联T波形态不同分观察组(心电图aVR导联T波正向,n=66)和对照组(心电图aVR导联T波非正向,n=74)。比较两组基线资料、临床各项检查指标及冠状动脉病变相关情况,并采用多元Logisitic回归分析老年STEMI患者心电图aVR导联T波形态正向的影响因素。结果观察组Killip分级、脑钠肽、肌钙蛋白、左心室射血分数、肌酸激酶同工酶和>2个梗死部位、前降支病变比例及冠状动脉病变支数与对照组比较,差异均有统计学意义(P值均<0.05)。老年STEMI患者心电图aVR导联T波形态正向独立危险因素包括脑钠肽、肌钙蛋白、冠状动脉多支病变,而独立保护因素为左心室射血分数。结论心电图aVR导联T波形态正向可预测老年STEMI患者冠脉多支病变,其冠脉病变程度有效预测可通过密切监测患者心电图aVR导联T波形态变化实现。

Objective To explore the clinical application effect and value of ECG aVR lead T wave morphology in assessing the degree of coronary artery disease in elderly patients with ST-segment elevation myocardial infarction(STEMI).Methods The clinical data of 140 elderly patients with STEMI admitted to our hospital from July 2020 to July 2022 were retrospectively analyzed,and the patients were divided into the observation group(positive T wave of lead aVR in ECG,n=66)and the control group(non positive T wave of lead aVR in ECG,n=74)according to the different shapes of T wave of lead aVR in ECG.Baseline data,clinical examination indexes and coronary artery disease were compared between the two groups,and multiple logistic regression was used to analyze the factors affecting the positive T-wave shape of aVR lead in elderly STEMI patients.Results There were statistically significant differences between the observation group and the control group in terms of killip grade,brain natriuretic peptide,troponin,left ventricular ejection fraction,creatine kinase isoenzyme and>2 infarction sites,the proportion of anterior descending artery lesions and the number of coronary artery lesions(P<0.05).The positive independent risk factors of T-wave shape in lead aVR of ECG in elderly patients with STEMI include brain natriuretic peptide,troponin,and coronary artery multi-vessel disease,while the independent protective factor is left ventricular ejection fraction.Conclusions The positive shape of T wave in lead aVR of ECG can predict the coronary multi-vessel lesions in elderly patients with STEMI,and the effective prediction of the degree of coronary lesions can be achieved by closely monitoring the changes of T wave in lead aVR of ECG.