急性前壁ST段抬高心肌梗死伴下壁导联ST段不同改变与冠状动脉病变的关系

The relationship between the acute anteriorl ST elevation myocardial infarction with different ST segment changes in inferior leads and coronary artery lesions

目的:探讨急性前壁ST段抬高心肌梗死伴下壁导联ST段不同改变,与冠状动脉病变的关系以及对患者近期预后的影响。方法:回顾性分析308例急性前壁心肌梗死患者心电图表现,根据下壁导联心电图ST段变化分为两组:A组为Ⅱ、Ⅲ、aVF中至少2导联抬高;B组为Ⅱ、Ⅲ、aVF中至少2导联压低。比较两组之间心肌梗死面积,左心室重构指标,梗死相关动脉相关性以及近期预后。结果:与B组相比,A组CK-MB最大值较低[(111.46±64.65)vs.(179.79±96.06)IU/L,P<0.0l];左心室射血分数较高,为[(52.28±12.62)vs.(46.81±5.79)%,P<0.01];室壁运动分数低[(20.38±5.65)vs.(38.48±5.28),P<0.01]。两组梗死相关血管(infarct related artery,IRA)A组患者中30例(35.29%)为包绕心尖部前降支(wrapped left anterior descending artery,WLAD),55例(64.71%)为非包绕心尖部前降支(non-wrapped left anterior descending artery,NWLAD),B组患者中7例(3.14%)为WLAD,216例(96.86%)为NWLAD,两组梗死相关血管比较,差异有统计学意义(P<0.01)。下壁导联ST段抬高幅度较大,并伴有ST段抬高幅度V1>V3导联。室壁运动分数与左心室功能呈负相关;与心电图抬高导联数呈负相关,与Ⅱ、Ⅲ、aVF导联抬高幅度呈负相关;与sumSTE呈负相关;并与血浆尿素氮、LDL、TG及体质量呈负相关。主要心血管事件(major cardiovascular events,MACE)两组间差异无统计学意义。结论:IRA为左前降支(left anterior descending artery,LAD)的急性前壁ST段抬高心肌梗死时,下壁导联ST段改变可能与LAD长度和病变部位有关;前壁导联合并下壁导联ST段同时抬高的患者若IRA为WLAD,其梗死面积较小,心功能较好。

Objective：To explore acute anteriorl ST elevation myocardial infarction with different ST segment changes in inferior leads and the relationship between the short-term prognosis and coronary artery le- sions. Methods： In a retrospective ECG analysis based on the inferior ST segment of electrocardiogram changes, 308 cases of acute anterior-wall myocardial infarction were divided into 2 groups： group A with elevation in at least two leads in II, III, aVF; group B with depression in at least two leads in II, III, aVF. A comparison be- tween the 2 groups included CK-MB maximum, left ventricular ejection fraction （LVEF） and infarct-related ar- tery （IRA）. Results： In comparison with group B the maximum CK-MB of group A was lower [ （ 111.46 ± 64.65） vs. （179.79 ±96.06）IU/L, P 〈 0.01 1; LVEF was higher E （ 52. 28 ±12.12 ） Vs. （46.81 ± 5.79）%, P 〈 0. 01 ] ; ventricular wall motion score was lower （ 20. 32± 10. 35） vs. （40 ± 15.24）. IRAfindings in the 2 groups were ： in group A patients approximately 30 （ 35.29% ） cases were wrapped around the apical left anterior descending artery （ WLAD ） , 55 （ 64. 71% ） eases were non-wrapped around the apical left anterior descending artery （ NWLAD ） ; in group B patients with 7 （ 3.14% ） eases of WLAD, 216 （96. 86% ） eases of NWLAD, two groups of infarct related artery compared with statistical difference. Inferior ST segment increase greatly, with ST segment elevation lead V1 〉 V3. Wall motion score was negatively corre- lated with left ventrieular function, the number of leads ECG elevation, II, III, aVF lead elevation, sum STE, LDL, TG and body quality. There is no significant difference in major adverse eaediae events （ MACE ） be- tween the 2 groups. Conclusion：In IRA LAD anterior-wall acute myocardial infarction, inferior ST segment ehange may be assoeiated with LAD length and lesion site; in patients where IRA was WLAD, inferior ST seg- ment elevation was associated with smaller infarct size, better heart function.