急性前壁心肌梗死时心电图预测左前降支阻塞部位的临床意义

Prediction of the obstructive site of left anterior descending coronary artery in anterior wall acute myocardial infarction by the admission electrocardiogram

目的 :探讨心电图ST段改变与冠状动脉病变部位的关系。方法 :对 76例急性前壁心肌梗死 (AA MI)病例进行回顾性分析。结果 :① 76例患者中 ,4 2例为前降支单支病变。 34例为前降支并发多支血管病变。根据前降支不同病变部位分为两组 :前降支近段病变组 (PD)、前降支远段病变组 (DD) ,两组间比较 :PD组在Ⅰ、aVL导联出现ST段抬高明显增加 ,差异有非常显著性意义 (P <0 .0 1) ,在Ⅱ、Ⅲ、aVF导联ST段压低明显增加 ,差异有显著性意义 (P <0 .0 5 )。② 34例前降支并发多支血管病变中 ,PD组同DD组比较 ,Ⅰ、aVL导联ST段抬高≥ 1mm者明显增加 ,Ⅲ、aVF导联ST段压低≥ 1mm者明显增加。Ⅱ导联压低≥ 1mm者有增加趋势 ,但差异无显著性意义 (P >0 .0 5 )。结论 :AAMI前降支阻塞时行心电图检查可以预测病变部位 ,Ⅰ、aVL导联ST段抬高 ,Ⅱ、Ⅲ、aVF导联ST段下移同前降支近段病变存在良性相关性。可视为对应性改变。前降支远段病变时Ⅱ、Ⅲ。

Objective:To study the relationship between change in ECG and obstructive site of coronary artery disease.Method:The significance of inferior and anterolateral ST segment changes in anterior acute myocardial infarction (AAMI) was studied in 76 patients who had coronary angiography. Result:① Seventy six patients were allocated into 2 groups (with proximal and distal lesion), including 42 patients with LAD single vessel coronary disease and 34 patients with LAD vassel associated multi vessels disease. Compared with those of LAD distal lesions, patients with LAD proximal stenosis had higher incidences of elevation of I, aVL ST segment (P< 0.01 ) and ST segmeat depression of Ⅱ,Ⅲ,aVF(P< 0.05 ).②The incidence of ST segment depression of Ⅲ, aVF≥1 mm and ST segment elevation of I, aVL≥l mm were higher in patients with LAD proximal stenosis than those in patients with LAD distal stenosis (P< 0.05 ) in 34 patients with multi vessel disease.The change of the ST segment depression in lead Ⅱ≥l mm occured more in patients with LAD proximal stenosis than those in patients with LAD distal stenosis, but P> 0.05 . Conclusion:It is possible to predict the site of LAD artery obstruction by the admission electrocardiogram of patients with AAMI. ST elevation in the anterolateral leads and ST depression in the inferior leads predict a culprit lesion in the proximal end of LAD artery, whereas isoelectric ST or ST elevation in the inferior leads suggests distal end of LAD artery occlusion.