预测急性下壁心肌梗死相关动脉的心电图特征

Electrocardiographic criteria for predicting the culprit artety in inferior wall acute myocardial infarction

目的 探讨下壁急性心肌梗死患者体表心电图对梗死相关动脉的预测价值。方法 根据冠状动脉造影结果将５１例下壁急性心肌梗死患者分为右冠状动脉闭塞组３５例和左冠状动脉回旋支闭塞组１６例。根据ａＶＬ导联ＱＲＳ形态分为Ⅰ型（Ｓ／Ｒ≤１／３，ＳＴ段压低≤１ｍｍ）和Ⅱ型（Ｓ／Ｒ＞１／３，ＳＴ段压低＞１ｍｍ）。结果 右冠状动脉闭塞时，ａＶＬ导联ＱＲＳ波多呈Ⅱ型变化，其敏感性和特异性分别为７７．１％。８１．３％。左冠状动脉回旋支闭塞时，则为Ⅰ型变化，其敏感性和特异性分别为８１．３％、７７．１％。结论 下壁急性心肌梗死患者的心电图ａＶＬ导联ＱＲＳ波呈Ⅱ型者是右冠状动脉阻塞敏感、特异的标志，呈Ⅰ型则是左冠状动脉回旋支阻塞敏感、特异的标志。

Objective The purpose of this study is to investigate the electrocardiographic criteria for predicting the culprit aitery in inferior wall acute myocardial infarction (AMI). Methods According to the features of electro- cardiogram (ECG)in lead aVL, patients were divided into Pattern I (S/R≤1/3, ST-segment depression≤1mm) and Pattern Ⅱ (S/R> 1/3, ST-segment depression> 1mm), infarction related arteries (IRA) were divided into entities of right coronary artery (RCA) (35 cases)or left circumflex artery (LCX) (16 cases)confirmed by coronary arteriography in 51 patients with inferior wall AMI. Results The incidence of Pattern Ⅱ was higher in RCA group than that in LCX group (P <0.05), with the sensitivity and specificity of 77.1% and 81.3% respectively in predicting occlusion of RCA. The incidence of Pattern I was higher in LCX group than that in RCA group (P <0.05) with the sensitivity and specificity of 81.3% and 77.1% respectively in predicting occlusion of LCX. Condusion Pattern I of the QRS complex in lead aVL is a sensitive and specific marker for LCX artery occlusion, whereas pattern Ⅱ suggests RCA related AMI diseases.