老年前壁急性心肌梗死患者高侧壁下壁导联ST段变化预测前降支阻塞的部位

Role of ST-segment changes in predicting left anterior descending branch occlusion in elderly patients with anterior AMI

目的探讨老年前壁急性心肌梗死（AMI）患者高侧壁、下壁导联ST段变化预测左前降支（LAD）阻塞部位的准确性。方法选择2010年6月~2015年3月在井冈山大学附属医院心内科就诊的306例老年前壁AMI患者,高侧壁、下壁导联ST段变化预测LAD阻塞部位,与LAD冠状动脉造影阻塞部位进行对比分析。以大对角支（LD）或第一对角支（D1）为界划分为LAD近、远段。结果 306例老年前壁AMI患者中心电图STⅠ、aVF导联抬高〉0.1mV 96例（31.4%）,STⅡ、Ⅲ、aVF导联压低≥0.1 mV 92例（30.1%）。STⅠ、aVL导联抬高〉0.1 mV判断LAD阻塞部位在D1或LD开口近段的敏感性（61.2%vs 62.7%）,差异无统计学意义（P〉0.05）;特异性（82.7%vs 93.0%,P=0.003）,阳性预测值（62.5%vs 87.5%,P=0.000）;STⅡ、Ⅲ、aVF导联下移≥0.1mV判断LAD阻塞部位在D1或LD近段的敏感性（65.3%vs 64.2%）,差异无统计学意义（P〉0.05）;特异性（86.5%vs96.5%,P=0.001）、阳性预测值（69.6%vs 93.5%,P=0.000）。结论老年前壁AMI患者高侧壁、下壁导联ST段变化LAD阻塞部位在LD近段的可能性大。

Objective To study the role of ST-segment changes in predicting left anterior descending（LAD）branch occlusion in elderly patients with anterior AMI.Methods LAD branch occlusion in 306 elederlty anterior AMI patients admitted to our hospital from June 2010 to March 2015 was predicted according to their ST-segment changes on the lateral and inferior leads and compared with the occlusion detected by coronary arteriography.The coronary artery was divided into proximal and distal segments according to the large diagonal（LD）or the first diagonal（D1）.Results The ST-segment elevation was〉0.1mV in 96（31.4%）and depression≥0.1mV in 92（30.1%）out of the 306 anterior elderly AMI patients.NO significant difference was found in the sensitivity of ST-segment elevation〉0.1mV or depression≥0.1mV to identify the LAD occlusion（61.2%vs 62.7%,65.3%vs 64.2%）,LAD was bounded either D1 or LD.The specificity of boundary as D1 was significantly lower than that of boundary as LD to identify the LAD occlusion（82.7%vs 93%,P=0.003,86.5%vs 96.5%,P=0.001）,ST-segment either elevation〉0.1mV or depression≥0.1mV.The positive predictive value of boundary as D1 was significantly lower than that of boundary as LD to identify the LAD occlusion（62.5% vs 87.5%,P=0.000,69.6%vs 93.5%,P=0.000）,ST-segment either elevation〉0.1 mV or depression≥0.1 mV.Conclusion LAD occlusion usually occurs in the proximal LD according to the ST-segment elevation in elderly anterior AMI patients.