急性ST段抬高型心肌梗死行急诊经皮冠状动脉介入前心电图预判冠脉闭塞部位的临床价值

Clinical value of electrocardiogram for the site of coronary artery vascular occlusion during acute myocardial infarction with ST segment elevation before the emergency PCI operation

目的探讨急性ST段抬高型心肌梗死(STEMI)急诊经皮冠状动脉介入(PCI)术前心电图预判冠脉闭塞部位的临床价值。方法全面分析311例STEMI患者18导联心电图改变,预判出冠状动脉闭塞的部位,与冠状动脉造影结果进行对比分析。结果急性广泛性前壁心梗心电图预判的敏感性、特异性分别为88.1%、81.2%(47/58),前间壁为90.2%、79.6%(78/98),前侧壁为69.3%、57.7%(30/52)。急性下壁心肌梗死心电图预判的敏感性、特异性分别如下:右冠状动脉近端96.1%、90.4%(47/52);远端83.3%、92.7%(51/55);左冠状动脉回旋支为50.0%、97.0%(96/98)。结论通过18导联心电图,绝大部分病例能在术前较精确地预判冠状动脉的急性闭塞部位,有利于急诊PCI的顺利进行,对于指导STEMI的治疗、手术风险的评估、预测患者的预后等均有重要的临床意义。

Objective To assess the clinical value of electrocardiogram（ECG） for diagnosing the sites of coronary artery vascular occlusion during acute myocardial infarction（AMI）with ST segment elevation before emergency PCI operation.Methods The data of 18 leads ECG in 311 patients with ST segment elevation myocardial infarction were analyzed.The predicted sites of occluded vessel were compared with the results of coronary arteriography（CAG）.Results The sensitivity and specificity of ECG were 88.1% and 81.2%（47/58）,for acute extensive anterior wall myocardial infarction,90.2% and 79.6%（78/98）,for anteroseptal myocardial infarction,69.3% and 57.7%（30/52）,for anterolateral wall myocardial infarction.The sensitivity and specificity of ECG were 96.1% and 90.4%（47/52）,for the proximal right coronary artery,83.3% and 92.7%（51/55）,for the distal right coronary artery,50.0% and 97.0%（96/98）,for circumflex branch of left coronary artery.Conclusion The results suggest that 18 leads ECG could forecast the related infarction coronary in most patients with acute myocardial infarction,which is conducive to the operation of emergency PCI,and has important clinical significance in guidance for the treatment of AMI with ST segment elevation,operational risk assessment and prognostic evaluation of patients.