急性下壁心肌梗死的相关动脉与体表心电图改变的关系

The relation between changes in electrocardiogram and infarction related artery in patients with acute inferior myocardial infarction

目的 对 5 0例急性下壁心肌梗死患者的心电图进行分析并与冠状动脉造影的结果进行比较 ,以揭示体表心电图对梗死相关动脉的预测价值。 方法 根据冠状动脉造影的结果将 5 0例急性下壁心肌梗死患者分为 3组 :右冠状动脉 (right coronary artery,RCA)闭塞组 2 4例 ,左回旋支 (left cir-cum flex artery,L CX)闭塞组 17例 ,右冠状动脉及左回旋支 (RCA+ L CX)同时闭塞组 9例。结果 (1)RCA组 ST 抬高 >ST 抬高的发生率明显高于 L CX组及 RCA+ L CX组 (P<0 .0 0 5 ) ,灵敏度、特异度、诊断符合率、阳性预测值及阴性预测值分别为 87.5 %、84.6 %、86 %、84%、86 % ;L CX组与 RCA+ L CX组后壁导联梗死图形的发生率明显高于 RCA组 (P<0 .0 0 5 ) ,阴性预测值分别为 84.6 %、10 0 % ;RCA组及 RCA+ L CX组右心室梗死的发生率明显高于 L CX组 (P<0 .0 1) ;(2 ) RCA组及 RCA+ L CX组侧壁导联 ST段下移的发生率及 STa VL下移 >STI 下移的发生率明显高于 L CX组 (P<0 .0 0 5～ 0 .0 5 ) ,其中a VL 导联 ST段下移及 STa VL 下移 >STI 下移对各自梗死相关动脉的阴性预测值分别为 76 .2 %、90 .5 %、73.3%、83.3% ;L CX组前壁导联 ST段下移的发生率明显高于 RCA组及 RCA+ L CX组 (P<0 .0 0 5～ 0 .0 5 ) ,其灵敏度。

Objective To predict the culprit artery in acute inferior myocardial infarction by assessing the relevant ST segment deviation of different leads. Methods The features of electrocardiograms in different leads was analyzed in three groups patients divided according to the infarction related artery (IRA) documented by coronary arteriography. Results (1)The incidence of ST segment elevation in lead Ⅲ higher than in lead Ⅱ was higher in right coronary artery (RCA) group than in left circumflex artery (LCX) and RCA+LCX groups ( P <0 005),and had a better sensitivity (Se),specificity (Sp),efficiency (e ),positive predictive value (PPV) and negative predictive value (NPV) in predicting RCA obstruction.The incidence of ST segment elevation in V 7～V 9 lead was higher in LCX and RCA+LCX groups than in RCA group ( P <0 005),the incidence of ST segment elevation in V 3R ～V 5R lead was higher in RCA and RCA+LCX groups than in LCX group ( P <0 005),both of the above mentioned indexes had better Se and NPV in predicting IRA;(2)The incidence of ST segment depression in lead Ⅰ and aVL and deeper ST segment depression in lead aVL than in lead I were higher in RCA and RCA+LCX group than in LCX groups ( p <0.005～0.05),The incidence of ST segment depression in lead V 1～V 6 were higher in LCX and RCA+LCX group than in RCA groups ( P <0 005～0 05). Conclusion A higher ST segment elevation in lead Ⅲ than in lead Ⅱ、a deeper ST segment depression in lead aVL than in lead Ⅰ、ST segment elevation in V 7～V 9 lead、ST segment elevation in V 3R ～V 5R lead、ST segment depression in lead V 1～V 6 are sensitivity and specificity markers for predicting IRA in this group of inferior wall acute myocardial infarction.