急性下壁心肌梗死胸前导联ST段压低与冠状动脉病变的关系及临床意义

CLINICAL SIGNIFICANCE OF PRECORDIAL ST SEGMENT DEPRESSION IN PATIENTS WITH ACUTE INFERIOR MYOCARDIAL INFARCTION AND ITS RELATION WITH THE LESION OF CORONARY ARTERY

目的 探讨急性下壁心肌梗死心电图胸前导联ST段压低与冠状动脉病变的关系及临床意义。方法 选择 1999年 1月～ 2 0 0 4年 3月住院诊治并行冠状动脉造影的首次急性下壁心肌梗死患者 6 6例 ,分析其心电图和冠状动脉造影资料 ,并根据其胸前导联ST段的压低范围分为 4组 :无胸前导联ST段压低组(Ⅰ组 ,n =14 ) ;胸前导联V1-3 ST段压低组 (Ⅱ组 ,n =11) ;胸前导联V4-6ST压低组 (Ⅲ组 ,n =18) ;胸前导联V1-6ST段压低组 (Ⅳ组 ,n =2 3)。结果 Ⅲ、Ⅳ组较Ⅰ组冠状动脉多支病变的发生率增加 (P <0 0 1)。Ⅰ组、Ⅱ组、Ⅲ组和Ⅳ组前降支病变发生率分别为 2 8 6 %、18 2 %、72 2 %和 82 6 % ,与Ⅰ组比较 ,Ⅲ、Ⅳ组的左前降支病变比例高 (分别P <0 0 5和P <0 0 1) ;回旋支病变在Ⅰ、Ⅱ、Ⅲ、Ⅳ组分别占 35 7%、5 4 6 %、72 2 %、6 0 9%。与Ⅰ组比较 ,Ⅲ组的左回旋支病变比例高 (P <0 0 5 )。左前降支病变程度各组间无显著性差异 (P >0 0 5 )。结论 急性下壁心肌梗死胸前导联V1-3 ST段压低合并左冠状动脉病变的发生率低 ,而伴有胸前导联V4-6或V1-6ST段压低则多存在左前降支和 /或回旋支的严重狭窄病变 ,多支病变比例较高 ,有较大范围的心肌缺血。

Objective To study the significance of precordial ST segment depression in patients with acute inferior myocardial infarction and its relation with the lesion of coronary artery. Methods 66 patients with first acute inferior myocardial infarction were divided into four groups based on the admission electrocardiogram. Group Ⅰ:patients with no precordil ST segment depression (n=14); Group Ⅱ:those with ST segment depression in leads V 1 to V 3 only (n=11); Group Ⅲ:those with ST segment depression in leads V 4 to V 6 only (n=18) and Group Ⅳ: those with ST segment depression in leads V 1 to V 6 only (n=23). Clinical data including ECG and coronary angiograms were analyzed. Results The frequency of multivessel lesions in group Ⅲ and Ⅳ was higher than group Ⅰ(P<0.01). The frequency of LAD lesion was 28.6% in group Ⅰ, 18.2% in group Ⅱ, 72.2% in group Ⅲ and 82.6% in group Ⅳ, respectively. Group Ⅲ and Ⅳ had significantly higher LAD lesion frequency than group Ⅰ (P<0.05 and P<0.01, respectively). The frequency of LCX lesion in group Ⅲ was higher significantly than group Ⅰ (P<0.05). Conclusion The precordil ST segment depression in leads V 1 to V 3 in patients with acute inferior myocardial infarction suggests lower incidence of LAD lesion, whereas the precordil ST segment depression in leads V 4 to V 6 or V 1 to V 6 may suggest multivessel involvement and result from extensive myocardial ischemia caused by severe stenosis of LAD and/or LCX.