常规心电图对前壁下壁心肌梗死罪犯血管的预测价值

The Predictive Value of ECG ST-segment Elevation for the Infarct-related Artery in Acute Myocardial Infarction Patients with Combined Anterior and Inferior

目的:分析常规心电图对急性前壁下壁心肌梗死罪犯血管的预测价值。方法:选择41例急性前壁合并下壁ST段抬高的心肌梗死者作为研究对象,按冠脉造影资料将梗死罪犯血管分为右冠病变(RCA)组24例和左前降支病变(LAD)组17例,分别测量常规心电图12导联ST段偏移程度及发生的导联数,以计算比较两组间的差异及对不同冠脉之间的预测价值。结果:(1)两组的基线临床资料无显著差异性;(2)RCA组Ⅱ、Ⅲ、aVF导联ST段抬高幅度总和高于LAD组[(2.46±1.24)vs(1.77±0.61)mm,P<0.01],ST段抬高III/II>1(66%vs 28%,P<0.01)或V1/V3>1(75%vs 12%,P<0.05)在RCA组高于LAD组;LAD组V3导联ST段抬高幅度总和高于RCA组[(1.60±0.36)vs(4.44±2.65)mm,P<0.01)。结论:Ⅱ、Ⅲ、aVF、V3导联ST段抬高幅度总和及V1/V3比值在诊断急性下壁前壁心肌梗死中对梗死罪犯血管有重要预测价值。

Objective To investigate the predictive value of ECG ST-segment elevation for infarct-related artery（IRA） in acute myocardial infarction patients with combined anterior and inferior.Methods 41 acute myocardio infaction patients with combined anterior and inferior ST-segment elevation were enrolled in present study.According to the angiographic information,they were divided into two groups： group RCA consisted of 24 patients with culprit artery at right coronary artery（RCA）,and 17 subjects in group LAD with culprit artery at left anterior descending coronary artery（LAD）.Based on 12-lead ECG recordings,the differences in average ST amplitude and the extent of the ST-segment offset between two groups,as well as the relationship between ECG changes and infarct-related artery,were quantitatively assessed using student t test with SPSS software.Results Basic characteristics of enrolled subjects had no significant difference between two groups.Compared with group LAD,the total of ST-segment elevation amplitude in lead II,III,and AVF was higher in group RCA（2.46±1.24 vs 1.77±0.61,P0.01）,as well as a higher percentage of STⅢSTⅡ（66% vs 28%,P0.01） or STV1STV3 in group RCA（75% vs 12%,P0.05）.However,the amplitude sum of ST-segment elevation in lead V3 was more in group LAD than that in group RCA（1.60±0.36 vs 4.44±2.65,P0.01）.Conclusions The sum of ST-segment elevation amplitude in lead II,III,AVF and V3,as well as the ratio of STV1 to STV3, appeared to be of importance in identifying IRA in patients with combined anterior and inferior myocardial infarction.