aVR T波形态在评价老年ST段抬高型心肌梗死冠状动脉病变严重程度中的意义

Significance of T-wave pattern in lead aVR in evaluation of coronary artery disease in elderly patients with ST-segment elevation myocardial infarction

目的探讨aVR T波形态与老年ST段抬高型心肌梗死(STEMI)患者冠状动脉病变严重程度的关系。方法160例老年STEMI患者按照入院时心电图aVR T波形态分为T波正向组(62例)和T波非正向组(98例),比较两组患者一般临床资料以及冠状动脉病变情况。结果与T波非正向组比较,T波正向组Killip分级、血清B型脑钠肽(BNP)、肌钙蛋白I(cTnI)、肌酸激酶同工酶(CK-MB)较高,而左心室射血分数(LVEF)较低,两组比较差异均有统计学意义(均P<0.05);T波正向组广泛前壁、>2个梗死部位、左前降支(LAD)病变比例高于T波非正向组(均P<0.05);T波正向组冠状动脉病变支数、Gensini积分严重程度分级均高于T波非正向组(均P<0.05);多元logistic回归分析显示,aVR T正向波是多支病变的独立危险因素(OR=1.557,95%CI:1.220~3.116,P=0.016);亦是Gensini积分>60分的独立危险因素(OR=1.429,95%CI:1.156~2.159,P=0.011)。结论 aVR T波正向老年STEMI患者冠状动脉病变较严重。

Objective To explore the relationship between T-wave pattern in lead aVR and coronary artery disease severity in elderly patients with ST-segment elevation myocardial infarction(STEMI).Methods 160 elderly patients with STEMI were enrolled and divided into positive T-wave group(n=62 cases)and non-positive T-wave group(n=98 cases)according to T-wave pattern in lead aVR at admission.Clinical data and coronary artery lesions were compared between the two groups.Results Killip classification,serum B-type brain natriuretic peptide,troponin I and creatine kinase isoenzyme were significantly higher and left ventricular ejection fraction was significantly lower in positive T-wave group then in non-positive T-wave group(all P<0.05).The ratio of extensive anterior myocardial infarction,more than two infarction sites and left anterior descending artery lesions,the number of lesion vessels,and the grade of Gensini sores were significantly higher in positive than in non-positive T-wave group(all P<0.05).Multiple logistic regression analysis showed that positive T-wave in lead aVR was an independent risk factor of multi-vessel lesions(OR=1.557,95%CI:1.220~3.116,P=0.016)and Gensini>60 scores(OR=1.429,95%CI:1.156~2.159,P=0.011).Conclusion Positive T-wave in lead aVR is related to serious coronary lesions in elderly patients with STEMI.