aVR导联ST段及QRS波时限改变临床价值探讨

ST-segment elevation in lead a VR and QRS duration as a predictor of left main or multi-vessel disease with non-ST segment elevation acute coronary syndrome

目的探讨非ST段抬高型急性冠脉综合征(NSTE-ACS)a VR导联ST(ST_(aVR))抬高及QRS波时限增宽对左主干或多支病变的预测价值。方法回顾性分析165例患者,与冠状动脉造影对比分析,探讨ST_(aVR)抬高(≥0.5mm)及QRS波宽度≥0.11s与左主干或多支病变的相关性。结果本组患者包括单支病变102例,左主干或多支病变63例。ST_(aVR)抬高及QRS时限增宽中,多支病变组发病率分别为82.54%、77.78%,单支病变组分别为17.65%、23.53%,两组间有统计学差异(p<0.001)。ST_(aVR)抬高及QRS波增宽对于预测左主干或多支病变的敏感性、特异性及准确性均较高,分别为82.53%、77.78%,83.35%、76.47%,以及82.42%、76.97%。结论综合STa VR抬高及QRS波宽度的改变,有助于NSTE-ACS患者左主干或多支病变的初步诊断。

Objective To investigate the diagnostic value of ST-segment elevation in lead aVR and widening of QRS wave duration for left main coronary artery or multi-vessel disease in non-ST segment elevation acute coronary syndrome （NSTE-ACS） patients. Methods 165 patients with NSTE-ACS were analyzed retrospectively through the comparison of coronary angiography. Comparatively analysis was done between ST-segment elevation in lead aVR （≥ 0.5mm）, widening of QRS wave （≥0.11s） , and left main coronary artery or multi-vessel disease. Results All the diseases were confirmed by coronary angiography, among which, 102 patients had single-vessel disease, and 63 cases had left main coronary artery or multi-vessel lesions. The rate of multi-vessel disease incidence for the elevation of ST-segment in aVR （≥0.5mm） and QRS wave width （≥0.1 1s） was 82.54% and 77.78% respectively, higher than that of single-vessel disease group （17.65%and 23.53%, respectively, p〈0.001）. The sensitivity, specificity and accuracy of ST-segment elevation in lead aVR （≥0.5mm） and QRS wave width （≥0.11s） for the prediction of left main coronary artery or multi-vessel lesions were 82.53% and 77.78%, 83.35% and 76.47%, and 82.42% and 76.97%, respectively. Conclusions Comprehensive ECG changes of ST-segment elevation in lead aVR and widening of QRS wave are helpful to the early diagnosis of NSTE-ACS in patients with left main or multi-vessel lesions.