心电图“镜面”导联改变对前壁心肌梗死合并冠状动脉多支病变的判定价值

Relationship between change of mirror lead and Anterior wall myocardial infarction with coronary multivessel disease

目的 研究急性前壁心肌梗死心电图“镜面”导联改变对合并冠状动脉多支病变的判断价值.方法 选择2010年3月至2014年5月入住湖北省新华医院首次发生急性前壁心肌梗死患者并行CAG和（或）经皮冠状动脉支架植入术（PCI）患者325例,分析其心电图的改变特征,并对比患者入院时的冠状动脉造影资料.结果 急性前壁心肌梗死伴下列1项或以上者对预测合并冠状动脉多支病变有较高的敏感度和特异度：①伴ST V1～V4 ↑ ＞0.4 mV＋QRS＞120 ms;②伴ST aVR＋aVL ↓;③伴ST I ↓;④伴QⅡ、Ⅲ、aVF;⑤伴Q aVR、aVL;⑥伴QⅢ＋ST V6↓.其中急性前壁心肌梗死伴①合并冠状动脉多支病变有较高的敏感度和特异度.结论 心电图“镜面”导联某些特征的改变对判定急性前壁心肌梗死合并冠状动脉多支病变有比较好的临床应用价值.

Objective Through the analysis of some characteristic changes of the acute anterior wall my- ocardial infarction （AAWMI） electrocardiogram, we compared them with the outcome of coronary angiography and researched the relationship between the change of mirror lead in AAWMI and coronary multivessel disease. Methods The clinical electrocardiogram change and the result of coronary angiography（CAG） of 325 patients with first AAWMI were analyzed in the study in Hubei Province Xinhua Hospital from 2010 March to 2014 May. Results AAWMI with the following paragraphs 1 or more may indicate coronary multivessel lesions： （1）AAWMI with ST V1-V4 〉0.4 mV＋QRS〉120 ms. （2）AAWMI with ST aVR＋aVL , （3）AAWMI with ST I （4）AAWMI with Q II, III ,aVF. （5）AAWMI with Q aVR,aVL. （6）AAWMI with QIlI＋ST V6 . It was the highest sensitivity and specificity that the AAWMI with （1） predicted multivessel coronary disease. Conclusion It is a good value for indicating muhivessel coronary lesions through the analysis of some characteristic changes of the acute anterior wall myocardial infarction electrocardiogram.