入院心电图对心肌梗死患者多支冠脉病变诊断价值

Diagnostic Value of Admission Electrocardiogram for Coronary MultipleBranch Lesions in Patients with Myocardial Infarction

目的探讨入院心电图对心肌梗死患者多支冠脉病变诊断价值。方法整群收集2013年2月—2014年12月该院急诊科就诊的220例前壁STEMI患者,患者均接受心电图检查和冠脉造影检查,分为下壁导联ST段抬高组68例,下壁导联ST段降低组152例。分析两组患者中心电图特征在单支冠脉病变和多支冠脉病变中的分布差异情况。结果下壁导联ST段降低时,a VL、V6导联出现ST段降低与多支血管病变明显相关,这种心电图特征所占比例在累及左前降支的多支病变患者中明显高于单支病变患者(P<0.05)。当下壁导联ST段抬高时,各导联心电图特征在单支病变和多支病变中的比例差异无统计学意义(P>0.05)。结论入院心动图变化对AMI患者多支冠脉病变具有一定的预测作用,通过下壁导联ST段改变可一定程度反映梗死相关动脉是左前降支或回旋支,还是右冠脉主干中之一。

Objective To discuss the diagnostic value of admission electrocardiogram for coronary multiple-branch lesions in patients with myocardial infarction. Methods 220 cases of patients with anterior wall STEMI treated in the emergency department of our hospital from February 2013 to December 2014 were collected and were given electrocardiography and coronary arteriography and divided into ST segment elevation in inferior wall leads group with 68 cases and ST segment depression in inferior wall leads group with 152 cases, the distribution difference of electrocardiogram characteristics in the coronary single-branch lesions and coronary multiple-branch lesions of the two groups was analyzed. Results ST segment depression was obviously correlated with multi-vessel disease ina VL and V6 leads at the time of ST segment elevation in inferior wall leads, the proportion of these electrocardiogram characteristics in patients with multi-vessel lesions involving left anterior descending branch was obviously higher than that in the single-vessel lesions（P〈0.05）, the difference in the proportion of electrocardiogram characteristics of each lead in single-vessel lesions and multi-vessel lesions was not statistically significant（P0.05）. Conclusion Admission kinetocardiogram change plays a certain predictive role in coronary multiplebranch lesions of AMI patients, and ST segment changes in inferior wall leads can reflect the infarction related artery is left anterior descending branch, left circumflex artery or one of right coronary artery backbones.