急性心肌梗死对应导联ST段变化与冠状动脉病变的关系

Correlation of angiographic changes and ST-segment depression in corresponding leads in patients with acute my-ocardial infarction

目的 用冠状动脉造影技术研究急性心肌梗死(AMI)对应导联ST段变化与冠状动脉病变的关系。方法136例急性心肌梗死共分五组:①组,前壁梗死(V1-6)伴有Ⅱ,Ⅲ,aVF导联ST段下移。②组,下壁梗死(Ⅱ,Ⅲ,aVF)同时伴有V1-6导联ST段下移。③组,下壁梗死(Ⅱ,Ⅲ,aVF)同时伴有I,aVL导联ST段下移。④组,前壁梗死(V1-6)未伴有其它导联的ST段变化。⑤组,下壁梗死(Ⅱ,Ⅲ,aVF)未伴有其它导联的ST段变化。所有患者均进行冠状动脉造影。结果 前壁心肌梗死伴有Ⅱ,Ⅲ,aVF导联ST段下移25例中有88%为左冠状动脉前降支病变,其中90.9%为左冠状动脉近端病变。前壁心肌梗死未伴有Ⅱ,Ⅲ,aVF导联ST段下移的36例患者中有94.4%为左冠状动脉前降支病变,两者统计无显著性差异。在下壁心肌梗死伴有V1-6导联ST段下移组22例中有81.8%为右冠状动脉病变,但同时伴有前降支病变的却有77.3%,其中单支病变仅18.2%。下壁心肌梗死未伴有V1-6导联ST段下移34例有91.2%为右冠状动脉病变,但同时伴有前降支病变的仅有32.4%,其中单支病变达52.9%。两组统计分别为P<0.001和P<O.01。下壁心肌梗死伴有1,aVL导联ST段下移19例中三支病变的占总数的52.6%,双支病变的占总数的21.1%,共占总数的73.7%。

Objective To assess the correlation of coronary lesion and ST-segment depression in corresponding leads in patients with acute myocardial infarction. Methods 136 patients with acute myocardial infarction were studied with coronary angiography and ST-segment measurements of initial electrocardiogram. Patients were divided into five groups: (1) Patients with anterior wall acute myocardial infarction (V1-6) and ST-segment depression in leads Ⅱ ,Ⅲ and aVF; (2) Patients with inferior wall acute myocardial infarction (Ⅱ,Ⅲ,aVF) and ST-segment depression in leads V1-6;(3) Patients with inferior wall acute myocardial infarction (Ⅱ,Ⅲ,aVF) and ST-segment depression in leads It aVL; (4) Patients with anterior wall acute myocardial infarction(V1-6) and without ST-segment change in other leads; (5) Patients with inferior wall acute myocardial infarction(Ⅱ,Ⅲ,aVF) and without ST-segment change in other leals. Results 88% of patients with anterior wall acute myocardial infarction and ST-segment depression in leads Ⅱ,Ⅲ and aVF were associated with left anterior descending coronary artery and same change were 94. 4% in those without ST-segment depression(P>0. 05). 77. 3% of patients with inferior wall a-cute myocardial infarction and ST-segment depression in leads V1-6 had lesion in left anterior descending coronary artery and those without ST-segment depression were 32. 4%(P<0. 001). 73. 3% of patients with inferior wall acute myocardial infarction and ST-segment depression in leads I, aVL was multivessel coronary disease. Conclusion The position of ST-segment depression of initial ECG in acute myocardial infarction were associated with lesion of coronary. It seems that patients with anterior wall acute myocardial infarction and ST-segment depression in leads Ⅱ,Ⅲ and aVF were only reciprocal changes but patients with inferior wall acute myocardial infarction and ST-segment depression in leads V1-6, were involved with left anterior descending coronary artery . Patients with inferior wall acute myocardial infarction and ST-segment depression in leads I, aVL indicated triple vessel coronary lesions.