心电图对老年急性下壁心肌梗死冠状动脉病变部位的预测价值

The value of electrocardiogram in predicting location of occlusion of infarct-related artery in inferior wall acute myocardial infarction of the elderly patients

目的 探讨急性下壁心肌梗死心电图与冠状动脉病变的关系 ,以揭示体表心电图对梗死相关动脉及病变节段的预测价值。方法 对 15 6例老年急性下壁心肌梗死患者的体表心电图和冠状动脉造影资料进行对比分析。结果 梗死相关动脉为右冠状动脉占 79.5 % ,左回旋支占 2 0 .5 %。单纯急性下壁心肌梗死病变节段多发生在第一右心室支开口以远 (77.6 % ) ,合并右心室心肌梗死病变节段多发生在第一右心室支开口前 (87% )。STⅢ 抬高 /STⅡ 抬高 >1,STⅠ、aVL下移≥ 1mm ,提示右冠状动脉为梗死相关动脉的敏感性分别为 87.9%、89.5 % ,特异性分别为 84 .4 %、81.2 % ,阳性预告值分别为 95 .6 %、94 .8% ,两者差异无显著性意义 (P >0 .0 5 )。ST段V1、V2 下移≥ 1mm ,提示左回旋支为梗死相关动脉的敏感性 ,特异性和阳性预告值分别为 84 .4 %、91.9%、73.0 %。

Objective To investigate the value of the electrocardiogram (ECG) in predicting the myocardial infarct related artery (IRA) and the location of occlusion in inferior wall acute myocardial infarction (IAMI).Method 156 elderly patients with IAMI who had accepted selective coronary angiography and ECG examination were studied.Results (1)IAMI was caused by right coronary artery (RCA) occlusion in 124(79.5%) cases and by left circumflex artery (LCX) occlusion in 32(20.5%).The location of RCA occlusion often occurred at the part distal to the origin of the first right ventricular branch in patients with mere IAMI.In patients with concomitant right ventricular infarction,the location of RCA occlusion often occurred at the part proximal to the origin of the first right ventricular branch.(2)ST Ⅲ elevation/ST Ⅱ elevation>1 or ST Ⅰ,aVL depression≥1 mm suggested RCA occlusion with sensitivity of 87.9% and 89.5%,specificity of 84.4% and 81.2% and positive predictive value of 95.6% and 94.8% respectively.The difference between these two methods was not significant(P>0.05).ST V 1,V 2 depression≥1 mm suggested LCX occlusion with sensitivity,specificity and positive predictive value of 84.4%,91.9%,73% respectively.Conclusion ECG has significant value in predicting the IRA and the location of occlusion in IAMI.