NSTEMI靶血管为左回旋支与右冠状动脉患者心电图特征的差异及意义

Difference and significance of electrocardiogram characteristics in patients of acute non-ST segment elevation myocardial infarction with left circumflex coronary artery and right coronary artery as target vessels

目的探讨急性非ST段抬高型心肌梗死(NSTEMI)靶血管为左回旋支(LCX)与右冠状动脉(RCA)患者心电图特征的差异及意义。方法选取2021年9月至2023年12月河南中医药大学第三附属医院收治的88例靶血管为LCX NSTEMI患者(LCX组)与70例靶血管为RCA NSTEMI患者(RCA组)纳入研究。比较两组患者的一般资料及心电图特征,采用受试者工作特征曲线(ROC)分析心电图特征对靶血管定位的鉴别诊断价值。结果两组患者的一般资料比较差异均无统计学意义(P>0.05);RCA组患者STⅠ降低、STⅢ↑>STⅡ↑、(ΣSTV_(1)~V_(3)↓/ΣSTⅡ、Ⅲ、aVF↑)≤1、STV4R升高患者占比分别为80.00%、92.86%、92.86%、45.71%,明显高于LCX组的26.14%、38.64%、51.14%、6.82%,STⅠ等电线、STⅡ↑>STⅢ↑、STV4R降低、V_(7)~V_(9)导联QRS波终末扭曲患者占比分别为20.00%、5.71%、2.86%、5.71%,明显低于LCX组的70.45%、60.23%、31.82%、53.41%,差异均有统计学意义(P<0.05);ROC分析结果显示,心电图各特征联合鉴别诊断LCX和RCA靶血管病变的曲线下面积(AUC)为0.907(95%CI:0.850~0.947),其敏感度为94.25%,特异度为87.14%,优于各特征单独鉴别诊断价值(P<0.05)。结论心电图特征为STⅠ降低、STⅢ↑>STⅡ↑、(ΣSTV_(1)~V_(3)↓/ΣSTⅡ、Ⅲ、aVF↑)≤1、STV4R升高对判断NSTEMI靶血管为RCA具有一定价值,STⅠ等电线、STⅡ↑>STⅢ↑、STV4R降低、V_(7)~V_(9)导联QRS波终末扭曲对判断NSTEMI靶血管为LCX具有一定价值,联合应用可作为临床鉴别诊断LCX与RCA靶血管的有效指标。

Objective To investigate the differences and significance of electrocardiogram characteristics between patients of acute non-ST segment elevation myocardial infarction(NSTEMI)with left circumflex coronary artery(LCX)and right coronary artery(RCA)as target vessels.Methods A total of 88 NSTEMI patients with LCX as target vessels(LCX group)and 70 NSTEMI patients with RCA as target vessels(RCA group)were selected from the Third Affiliated Hospital of Henan University of Chinese Medicine from September 2021 to December 2023.The general information and electrocardiogram characteristics of the two groups were compared,and the discriminatory diagnostic value of electrocardiogram characteristics for target vessel localization was analyzed using receiver operating characteristic(ROC)curve.Results There was no statistically significant difference in general information between the two groups of patients(P>0.05).The proportions of patients with decreased STⅠ,STⅢ↑>STⅡ↑,(ΣSTV_(1)-V_(3)↓/ΣSTⅡ,Ⅲ,aVF↑)≤1,and increased STV4R in the RCA group(80.00%,92.86%,92.86%,45.71%)were significantly higher than those in the LCX group(26.14%,38.64%,51.14%,6.82%);the proportions of patients with STⅠisoelectric line,STⅡ↑>STⅢ↑,decreased STV4R,and QRS wave terminal distortion in leads V_(7)-V_(9)(20.00%,5.71%,2.86%,5.71%)were significantly lower than those in the LCX group(70.45%,60.23%,31.82%,53.41%);the differences were statistically significant(P<0.05).ROC analysis showed that the area under the curve(AUC)of the combined use of various electrocar-diographic features for the differential diagnosis of LCX and RCA target vessel lesions was 0.907(95%CI:0.850-0.947),with a sensitivity of 94.25%and a specificity of 87.14%,which was superior to the value of each feature alone(P<0.05).Conclusion The electrocardiogram characteristics of STⅠdecrease,STⅢ↑>STⅡ↑,(ΣSTV_(1)-V_(3)↓/ΣSTⅡ,Ⅲ,aVF↑)≤1,STV4R increase are valuable for identifying the target vessel of NSTEMI as the RCA.The STⅠisoelectric line,STⅡ↑>STⅢ↑,STV4R decrease,and QRS wave terminal distortion in leads V_(7)-V_(9) are valuable for identifying the target vessel of NSTEMI as the LCX.The combined application can be used as an effective indicator for clinical differential diagnosis of LCX and RCA target vessels.