急性心肌梗死合并完全性右束支阻滞时ST段镜像改变的临床意义

Clinical significance of ST-segment mirror-image change in patients with acute myocardial infarction com-plicating complete right bundle branch block

目的探讨急性心肌梗死(acute myocardial infarction,AMI)合并完全性右束支阻滞(complete right bundle branch block,CRBBB)心电图ST段镜像改变的特点及其与罪犯血管定位的相关性。方法回顾性收集心电图诊断为AMI合并CRBBB的患者82例,根据ST段镜像改变存在与否分为镜像组(55例)和无镜像组(27例)。分析两组的临床资料、冠状动脉(简称冠脉)造影结果。将镜像组中存在冠脉狭窄的50例患者进一步分为下壁AMI组(16例)和前壁AMI组(34例)两个亚组,分析梗死相关血管的分布情况。结果镜像组患者中胸闷、胸痛持续时间≤6 h者占比明显高于无镜像组(P<0.01)。下壁AMI伴Ⅰ、aVL、V_(1)—V_(6)导联ST段压低的患者中,有90.9%为右冠脉病变,63.6%为多支病变;前壁AMI伴下壁导联ST段抬高的患者100%是前降支病变,85.7%是多支病变。结论AMI后越早采集心电图,镜像改变的发生率就越高。根据镜像改变可以预判梗死相关血管,明确病变累及的是单支还是多支冠脉,并评估心肌梗死范围的大小。

Objective To investigate the characteristics of ST-segment mirror-image change(MC)in electrocardiogram(ECG)among patients with acute myocardial infarction(AMI)complicated by complete right bundle branch block(CRBBB),and their correlation with culprit vessel location.Methods We retrospectively collected 82 patients diagnosed with AMI complicating CRBBB by ECG.They were divided into MC group(55 cases)and non-MC group(27 cases)according to the presence or absence of ST-segment MC.The clinical data and coronary angiography results of the two groups were analyzed.Fifty cases with coronary artery stenosis in the MC group were further divided into two subgroups:the inferior wall AMI group(16 cases)and the anterior wall AMI group(34 cases);the distribution of the infarction-related vessels was analyzed.Results The proportion of patients presenting as chest tightness and chest pain lasting no more than 6 hours in the MC group is significantly higher than that in the non-MC group(P<0.01).In the inferior wall AMI patients with ST-segment depression in leadⅠ,aVL and V_(1)-V_(6),those with right coronary lesions account for 90.9%while those with multi-vessel lesions account for 63.6%.All the anterior wall AMI patients with ST-segment elevation in inferior wall leads have anterior descending branch lesions,and 85.7%of them are multi-vessel involved.Conclusion The earlier the ECG is recorded after AMI,the higher the incidence of MC.Based on MC,infarction-related vessels can be predicted,whether the lesion involves a single vessel or multiple coronary arteries can be determined,and the myocardial infarct size can be assessed.