aVR导联ST段抬高在急性下壁心肌梗死相关动脉分析的作用

The Effects of Leading aVR ST Segment Elevation in Analyzing Infarct-related Artery in Acute Inferior Myocardial Infarction

目的在急性心肌梗死相关动脉分析中复杂的是下壁心肌梗死,本文采用aVR导联ST段改变识别下壁心肌梗死相关动脉和确定罪犯血管病变的位置。方法在143例入院下壁ST段抬高型心肌梗死患者中,记录aVR导联ST段变化,并进行冠脉造影。研究aVR导联ST段变化与梗死相关动脉和罪犯血管定位之间的关系。结果 aVR导联ST段抬高14例(9.8%)≥0.5 mm,56例(39.2%)无明显ST段改变,73例(51.0%)患者ST段压低≥0.5 mm。110例(76.9%)梗死相关动脉为右冠状动脉,33例(23.1%)为左回旋支。右冠脉为梗死相关动脉在3组中差异有统计学意义(ST段抬高组92.9%,ST段无明显改变组83.9%,ST段压低组为68.5%,P=0.039)。ST段抬高识别右冠脉病变的敏感性11.82%、特异性96.97%。ST段压低识别左回旋支病变敏感性69.70%,特异性54.54%。结论 ST段抬高型下壁心肌梗死患者,aVR导联ST段抬高高度提示右冠脉闭塞,ST段抬高与右冠脉近端病变相关。

Objective The complicated part of the analysis of infarct-related artery in acute myocardial infarction is inferior myocardial infarction. This study aims to identify infarct-related artery in inferior myocardial infarction and confirm the location of culprit lesion by the use of ST segment changes in leading aVR. Methods ST segment changes in leading aVR were recorded in 143 patients who were treated as inferior myocardial infarction with ST segment elevation, and then patients were treated with coronary angiogram. The relationship betweenST segment changes in leading aVR and infarct-related artery, and the relationship between that and the localization of culprit lesion were investigated respectively. Results ST elevation which was more than or equal to 0. 5 mm in leading aVR was present in 14 patients （9. 8% ） , ST segment changes were not significant in 56 patients （39. 2% ） and ST depression which was more than 0. 5 mm was present in 73 patients （51.0%）. There were 110 patients （76. 9% ） whose IRA were fight coronary artery （RCA） and 33 patients （23.1%） whose IRA were left circum ex artery （LCX）. Prevalence of RCA involvement as IRA was statistically significant among three research groups （92. 9% in ST elevation group, 83.9% in no obviously changed group and 68.5% in ST depression group, P = 0. 039）. Presence of ST elevation had the sensitivity and speei city of 11. 82% and 96. 97% respectively for detecting RCA lesions. Presence of ST depression had the sensitivity and speci city of 69. 97% and 54. 54% respectively for identifying LCX lesions. Conclusion Presence of ST elevation is highly suggestive of RCA lesions in patients with inferior myocardial infarction, whereas the absence of ST elevation cannot rule out RCA lesions.