aVR导联对急性前壁心肌梗死患者梗死相关血管的预测价值及临床意义

The value of lead aVR in identifying the infarcted-realted artery and prognosis in patients with acute anterior myocardial infarction

目的 研究aVR导联ST段抬高对急性前壁心肌梗死患者梗死相关血管的预测价值及临床意义.方法 101例首次急性前壁心肌梗死患者根据aVR导联有无ST段抬高分为A组（有ST段抬高）33例和B组（无ST段抬高）68例,对其冠脉造影、心脏彩超结果和临床资料进行比较.结果 ①梗死相关血管为左主干（LM）病变A组9例,B组2例,两组差异有统计学意义（P＜0.01）;梗死相关血管为左前降支（LAD）近端病变A组22例,B组26例,两组差异有统计学意义（P＜0.01）;多支血管病变A组15例,B组16例,两组差异有统计学意义（P＜0.01）.②A组发生心脏事件11例,B组9例,两组差异有统计学意义（P＜0.01）.③A组LVEF值明显低于B组（P＜0.01）.④A组CK-MB峰值明显高于B组（P＜0.01）.结论 aVR导联对急性心肌梗死患者梗死相关血管的判定及预后有重要的临床价值.

Objective To investigate the value of lead aVR in identifying the infarction-related artery and prognosis in patients with acute anterior myocardial infarction. Methods The electrocardiogram and coronary angiography in patients with acute anterior myocardial infarction were analyzed. Results （1）There was significant difference in the patients whose infarct-related artery was left main coronary artery between in the elevation group （9 cases, 27.3%） and no elevation group（2 cases, 2.9%）（P〈0.01 ）. The patients whose infarct-related artery was proximal left anterior descending coronary artery in elevation group （22 cases, 66.7% ） were significantly higher than that of no e]evation group（26 cases, 38.2%）（P〈0.01 ）. The cases with multi-vessel lesions in elevation group （15 cases, 45.4%） were significantly higher than in no elevation group（ 16 cases, 23.5%）（P〈0.01 ）. （2）The cases with heart incident in elevation group （11 cases, 33.3% ） were significantly higher than in no elevation group （9 cases, 9.9% ）（P〈0.01 ）. （3）The left ventricular ejection fraction （LVEF） was significantly lower in elevation group than in no elevation group （P〈0.05）. （4） The peak creatine kinase MB fractions was significantly higher in eleva-tion group than that in no elevation group （P〈0.01）. Conclusion ST segment elevation of aVR lead is useful for predicting infarcted-realted artery and prognosis in patients with acute anterior myocardial infarction.