心电图对急性下壁心肌梗死合并冠状动脉多支病变的判定价值

Electrocardiographic features of acute inferior infarction and their relationship with angiographic multivessel disease

目的研究急性下壁心肌梗死心电图某些特点对合并冠状动脉多支病变的判断价值。方法分析236例首次发生急性下壁心肌梗死患者的某些心电图的特征改变，与其入院时的冠状动脉造影（CAG）资料进行对比。结果急性下壁心肌梗死心电图伴下列1项或以上患者对预测合并冠状动脉多支病变有较高的敏感性和特异性：（1）伴STV4-V6↓；（2）伴STⅡ、Ⅲ、aVF↑〉0．2mV＋STaVH↑；（3）伴aVF导联低电压；（4）伴2个或以上胸前导联fQRs波；（5）伴STV4R↑T＋STaVL↓／STI↓〈1。其中急性下壁心肌梗死心电图伴sT，。叱J时对判定患者合并冠状动脉多支病变有较高的敏感性和特异性。结论急性下壁心肌梗死心电图某些特征的改变对判定患者合并冠状动脉多支病变有较好的临床应用价值。

Objective To analyse some characteristic changes of the electrocardiogram in acute inferior wall myocardial infarction compare them with the outcome of coronary angiography and study the relationship between these changes or electrocardiogram in acute inferior wall myocardial infarction and coronary muhivessel disease. Methods The electrocardiogram features and the results of coronary angiography （CAG） of 236 patients with first acute inferior wall myocardial infarction were analyzed in study. Results Acute inferior wall myocardial infarction together with one or more of the following features predicted patients having coronary multivessel disease： （1） Acute inferior wall myocardial infarction with STv4_v6 depression; （2） Acute inferior wall myocardial infarction with STII,III,avF elevation 〉 0. 2 mV ＋ STaVR elevation; （3） Acute inferior wall myocardial infarction with lead aVF low voltage; （4） Acute inferior wall myocardial infarction with two or more precordial leads fQRS waves; （5） Acute inferior wall myocardial infarction with STy4K elevation ＋ STavE depression/STI depression 〈 1. Among all these features, ECG of acute inferior infarction with STv4_v6 depression showed the highest sensitivity （90. 4% ） and specificity （91.1%） . Conclusions Through the analysis of some characteristic changes of the electrocardiogram in the acute inferior wall myocardial infarction can help prediction of the presence of coronary multivessel disease.