急性下壁心肌梗死患者心电图预测梗塞部位的研究

Study of Electrocardiographic Criteria for Predicting the Site of Coronary Artery Occlusion in Inferior Wall Acute Myocardial Infarction

目的 探讨心电图用于预测急性下壁心肌梗死患者梗塞部位的可行性.方法 利用标准12导心电图预测冠状动脉梗塞部位.如:右冠状动脉(RCA)右心室分支的近端梗塞,RCA右心室分支的远端梗塞,左回旋支(LCX)梗塞.选择152名首次发生下壁心肌梗死患者,症状发生后12h行冠状动脉血管造影.血管造影前全部患者采用标准12导心电图.结果V_3/Ⅲ比率分别是0.2±0.3,0.8±0.5,2.5±2.5,(P=0.0001).V_3/Ⅲ比率<0.5为RCA近端梗塞,V_3/Ⅲ比率>0.5或≤1.2为RCA远端梗塞V_3/Ⅲ比率>1.2为LCX梗塞,其敏感性分别为91%,93%,95%.结论 V_3/Ⅲ比率对预测急性下壁心肌梗死患者冠状动脉梗塞部位极有帮助.

Objective To asses the feasibility of electrocardiographic creteria for predicting the site of coronary artery occlution in inferior wall acute myocardial infarction. Methods standard 12-lead electrocardiograms obtained on admission could identify the site of coronary artery occlusion, (i. e. . a site proximal to the origin of the right ventricular branch of the right coronary artety [RCA], a site distal to the origin of the right ventricular branch of the RCA, or a site in the left circumflex coronary artery(LCX). The ratio of ST depression in lead V3 to ST elevation in lead Ⅲ (V3/ Ⅲ ratio) was evaluated immediately before coronary angiography in 152 patients with a first inferior wall AMI confirmed by coronaty angiography within 12 hours after the onset of symptoms. Results For occlusion of the proximal RCA, distal RCA, and LCX, V3/Ⅲ ratio was 0. 2±0. 3, 0.8 ± 0. 5, and 2. 5?. 5(P = 0. 0001), respectively. The V3/ Ⅲ ratio<0. 5 identified proximal RCA occlusion, 0. 5<V3/ Ⅲ ratio ≤1. 2 identified distal RCA occlusion, and 1. 2<V3/ Ⅲ ratio identified LCX occlusion with sensitivities of 91% ,84% ,and 84 % ,and specificities of 91 % ,93% ,and 95% , respectively. Conclusion V3/ Ⅲ ratio is useful in predicting the site of coronary artery occlusion in patients with inferior wall AMI.