急性下壁心肌梗死时心电图与冠脉造影结果分析

Sequence analysis of electrocardiogram characteristics and coronary angiography in patients with inferior wall acute myocardial infarction

目的 探讨下壁急性心肌梗死 (AMI)患者体表心电图对判断心肌梗死相关动脉的作用。方法 对 40例下壁AMI患者的心电图和冠状动脉造影资料进行分析。结果 ①血管闭塞发生在右冠状动脉者占 65 % ,左回旋支占 35 % ;②下壁AMI时I、avl导联ST段呈对应性压低 ,提示右冠状动脉为心肌梗死相关动脉的敏感性为 76 .9% ,特异性为 2 8.6 % ;ST段呈等电位线或轻度抬高 ,提示回旋支闭塞的敏感性为 2 8.6 % ,特异性为 76 .9% ;ST段抬高幅度Ⅲ >Ⅱ时诊断右冠状动脉闭塞的敏感性为 1 0 0 % ,特异性为 57.1 % ;ST段抬高幅度Ⅱ >Ⅲ时提示左回旋支闭塞的敏感性为 50 % ,特异性为1 0 0 % ;ST段抬高幅度Ⅲ >Ⅱ提示右心室心肌梗死的敏感性为 1 0 0 % ,特异性较低为 2 4 .2 %。结论 下壁AMI时心电图对判断梗死相关动脉有重要的预测价值。

Objective To investigate the value of electrocardiogram (ECG) in predicting myocardial infarct-related artery (IRA) in patients with inferior acute myocardial infarction (IAMI). Methods The ECG characteristics and angiography's information in 40 patients with IAMI were retrospectively analyzed. Results ① IAMI was caused by right coronary artery (RCA) occlusion in 26 (65%) cases, left circumflex artery (LCX) occlusion in 14 (35%) cases. ② ST reciprocal depression in leads I,av1 identified RCA occlusion with a sensitivity of 76.9%, specificity of 28.6% in patients with IAMI, but isoelectric or slightly elevated ST segment in leads I, av1 identified circumflex occlusion with a sensitivity of 28.6%, specificity of 76.9%, ST Ⅲ>Ⅱ identified RCA occlusion with a sensitivity of 100%, specificity of 57.1%. ST Ⅱ>Ⅲ identified LCX occlusion with a sensitivity of 50%, specificity of 100%. ST Ⅲ>Ⅱ as diagnostic index of right ventricular infarction (RVI) had the highest sensitivity (100%) and lower specificity (24.2%). Conclusions Electrocardiogram is of great value in predicting the infarct-related artery in inferior wall acute myocardial infarction.