急性下壁心肌梗死伴胸前导联ST段压低的临床意义

Clinical implication of precordial ST segment depression in acute inferior myocardial infarction

目的评价急性下壁心肌梗死伴胸前导联ＳＴ段压低的临床意义。方法３３例急性下壁心肌梗死患者早期心电图与入院后３周冠脉造影对照，观察急性下壁心肌梗死伴胸前导联ＳＴ段压低与左前降支、多支血管病变、心肌酶峰值、ＳＴⅢ抬高＞ＳＴⅡ及右冠病变部位关系。结果胸前导联ＳＴ段压低者２２例（６７％），其中合并左前降支及多支血管病变者分别为９例和１０例，而胸前导联无压低者分别为５例和６例，二者无显著差异；但前者有较高ＣＫ、ＬＤＨ和ＧＯＴ峰值（Ｐ＜０．０２５、Ｐ＜０．００５及Ｐ＜０．０５）。２６例梗死相关动脉为右冠者中，１６例ＳＴⅢ抬高＞ＳＴⅡ合并胸前导联ＳＴ段压低１３例，造影显示右冠近端病变１３例，而１０例ＳＴⅢ抬高≤ＳＴⅡ者合并胸前导联ＳＴ段压低４例，右冠近端病变３例，二者均有显著差异。结论胸前导联ＳＴ段压低与左前降支或多支血管病变无关，但有较大梗死面积；胸前导联ＳＴ段压低与ＳＴⅢ抬高＞ＳＴⅡ有良好关联及共同解剖学特征，即右冠近端病变。

Objective To evaluate the clinical implication of precordial ST segment depression in acute inferior myocrdial infarction(AIMI).Methods ECG on admission of 33 AIMI patients and their coronary angiography(CAG) performed 3 weeks thereafter were analyzed,in order to indentify the interrelationship among precordial ST sedment depression in AIMI and LAD lesions,multivessel lesions,peak enzyme value,ECG presentation of ST Ⅲelevation>ST Ⅱand location of RCA lesions.Results Precordial ST segment depression was noted in 22 cases(67%),including 9 cases of LAD lesions and 10 cases of multivessil lesions.Among those without ST segment depression,five were with LAD lesions and 6 with multivessel involvement.But peak enzymes(CK,LDH and GOT) were significantly higher in those with ST depression( P <0 025, P <0 005 and P <0 05,respectively).RCA was indentified as infarct-related artery in 26 patients.Among 16 with ST Ⅲelevation≤ST Ⅱ,only 4 were with precordial ST depression.Three of the 10 patients had culprit lesions in proximal RCA.The differences were of significance.Conclusion Precordial ST depression is not associated with LAD lesion or multivessel diseases,but with larger infarct size,Precordial ST depression correlated well with ECG presentation of ST Ⅲelevation>ST Ⅱ.Both of them share the same anatomical bases:proximal RCA lesion.