急性心肌梗死时体表心电图对梗死相关动脉的判断

Value of electrocardiogram in predicting the myocardial infarct-related artery and the location of occlusion in acute myocardial infarction

目的 了解急性心肌梗死 (AMI)的体表心电图对心肌梗死相关动脉 (IRA)及其闭塞位置判断作用。方法 对 2 6 4例急性心肌梗死患者的心电图和冠状动脉造影资料进行回顾性对比分析。结果 ①下壁AMI时血管闭塞发生在右冠状动脉 (RCA) 74例 (78 7% ) ,左回旋支 (LCX) 2 0例(2 1 3% )。Ⅰ、aVL导联ST段压低提示RCA为IRA的敏感性 ,特异性和阳性预测值分别为 94 6 % ,70 %和 92 1%。ST段压低Ⅰ <aVL提示RCA为IRA的敏感性 ,特异性和阳性预测值分别为 83 8% ,90 %和 96 9%。ST段抬高Ⅱ <Ⅲ提示RCA为IRA的敏感性 ,特异性和阳性预测值分别为 90 5 % ,90 %和 97 1%。ST段压低Ⅰ <aVL和ST段抬高Ⅱ <Ⅲ提示RCA为IRA的敏感性 ,特异性和阳性预测值分别为 81 8% ,10 0 %和 10 0 %。非ST段压低Ⅰ <aVL和非ST段抬高Ⅱ <Ⅲ提示LCX为IRA的敏感性 ,特异性和阳性预测值分别为85 % ,10 0 %和 10 0 %。 13例合并右室心梗IRA均为RCA。②前间壁AMI时STⅠ 、STaVL抬高 ,STⅡ、Ⅲ、aVF下降均不能提示IRA为LAD或RCA(P分别大于 0 0 5 )。③前壁AMI时STⅠ 、STaVL抬高 ,STⅡ、Ⅲ、aVF下降判断LAD近段闭塞的敏感性、特异性和阳性预测值分别为 70 4 % ,5 9 3% ,87% ,95 7%和 86 4 % ,94 1%。④广泛前壁AMI时STⅠ 、STaVL抬高 ,ST?

Objective To investigate the value of electrocardiogram in predicting the myocardial infarct related artery and the location of occlusion in acute myocardial infarction. Methods 264 patients with AMI were analyzed retrospectively. Results ①Inferior wall acute myocardial infarction (IAMI) was caused by RCA occusion in 74(78.7%), by LCX occusion in 20(21 3%) cases. ST segment depression in Ⅰ, aVL identified RCA occlusion with sensitivity, specificity and positive predictive value of 94.6%, 70% and 92.1%, respectively. ST segment depression ratio Ⅰ/aVL<1 identified RCA occlusion with sensitivity, specificity and positive predictive value of 83.8%, 90% and 96.9%, respectively. ST elevation ratio Ⅱ/Ⅲ<1 identified RCA occlusion with sensitivity, specificity and positive predictive value of 90.5%, 90% and 97.1%, respectively. Both ST segment depression ratio Ⅰ/aVL<1 and ST elevation ratio Ⅱ/Ⅲ<1 identified RCA occlusion with sensitivity, specificity and postive predictive value of 81.1%, 100% and 100%, respectively. Neither ST segment depression ratio Ⅰ/aVL<1 nor ST elevation ratio Ⅱ/Ⅲ<1 identified LCX occlusion with sensitivity, specificity and postive predictive value of 85%, 100% and 100%, respectively. All concomitant right ventricular infarction were found in 13 patients with RCA occlusion. ② ST segment elevation in Ⅰ,aVL or depression in Ⅱ,Ⅲ, aVF could not identify RCA or LAD occlusion in patients with anteroseptal wall AMI. ③ During anterior wall AMI, ST segment elevation in Ⅰ, aVL or depression in Ⅱ, Ⅲ, aVF identified LAD lesion proximal occlusion with sensitivity, specificity and postive predictive value of 70.4%, 59 3%, 87%, 95 7% and 86.4%, 94.1%, respectively. ④ During wide anterior wall AMI, ST segment elevation in Ⅰ, aVL or depression in Ⅱ,Ⅲ, aVF identified LAD lesion proximal occlusion with sensitivity, specificity and postive predictive value of 100%, 95 5%, 85.7%, 100% and 97.8%, 100%, respectively. Conclusion Electrocardiogram have significant valve in predicting the IRA and the location of occlusion in inferior, anterior and wide anterior wall AMI