急性前壁心肌梗死时心电图对预测冠状动脉前降支闭塞位置的作用

Prediction of the Site of Left Anterior Descending Coronary Artery Occlusion During Anterior Wall Acute Myocardial Infarction by the Routing Electrocardiogram

目的：探讨心电图对准确预测前壁急性心肌梗死（ＡＭＩ）时冠状动脉前降支（ＬＡＤ）闭塞位置的作用。方法：对９４例前壁ＡＭＩ患者的心电图和冠状动脉造影资料进行分析。结果：①前间隔ＡＭＩ患者前降支闭塞位置大都发生在第１间隔支和第１对角支开口远端，且单支病变多见。②前壁和前壁伴高侧壁ＡＭＩ患者前降支闭塞位置发生在第１间隔支与第１对角支开口近端的发生率分别为２８９％与２６３％和５５０％与４７５％。前壁伴高侧壁ＡＭＩ患者若以大的对角支作为解剖分界进行分析，则８００％其血管闭塞位置在大的对角支发出前，若以ａＶＬ导联ＳＴ段抬高＞１ｍｍ，Ⅲ、ａＶＦ导联ＳＴ压低＞１ｍｍ为标准，预测血管闭塞位置在第１对角支开口近端和大对角支开口近端的发生率分别为６９２％和９２３％。③前壁伴下壁ＡＭＩ者前降支闭塞位置均发生在第１间隔支开口远端。

Objective:To predict the exact site of the occlusion of left anterior descending coronary artery(LAD)by analyzing admission electrocardiogram and coronary angiographic data. Methods:Ninty four patients with anterior wall acute myocardial infarction (AMI) were studied. Results:①The location of the LAD coronary artery occlusion occured at distal to the origin of the first septal breach (S1) and the first diagonal branch(D1) in the most of the patients with anteroseptal AMI.②The level of LAD artery obstruction proximal to the origin of the S1 and the D1 was detected in 28 9% and 26.3% of the patients with anterior wall AMI,respectively,and in 55 0% and 47.5% of the patients with anterior wall plus high anterolateral wall AMI,respectively.If the larger diagonal as the boundary,the location of LAD artery occlusion was proximal to the origin of the larger diagonal in 80 0% of the patients with anterior wall plus high anterolateral wall AMI.The electrocardiogram with ST elevation >1 mm in lead aVL and ST depression >1 mm in leads Ⅲ、aVF have a predictive value of 69.2% and 92.3% for an LAD artery occlusion proximal to the D1 and to the larger diagonal.③ The location of the LAD coronary artery occlusion always occured at distal to the origin of the S1 and the D1 in the patients with anterior inferior AMI. Conclusion:Electrocurdiogram have an important value in predicting the exact site of the occlusion of LAD.