Ⅱ、ⅢST段抬高比值与ⅠST段偏移对急性下壁心肌梗死相关动脉的诊断价值

Dignostic values of ST elevation Ⅱ/Ⅲ ratio and ST deviation in lead Ⅰ for identifying infarct-related artery in inferior wall acute myocardial infarction

目的探讨急性下壁心肌梗死体表心电图对梗死相关动脉的诊断价值。方法对照分析61例急性下壁心肌梗死入院时心电图Ⅱ、Ⅲ导联ST段抬高比值及Ⅰ导联ST段偏移与冠状动脉造影梗死相关动脉的关系。结果14例左旋支阻塞所致者ST段抬高Ⅱ/Ⅲ≥1、<1分别为12、2例;Ⅰ导联ST段抬高或等点线12例,压低2例。而47例右冠状动脉阻塞所致者ST段抬高Ⅱ/Ⅲ≥1、<1分别为2、45例;Ⅰ导联ST段抬高或等电位线2例、压低45例。两组差异有显著性意义。结论心电图ST段抬高Ⅱ/Ⅲ≥1、Ⅰ导联ST段抬高或等电线是诊断左旋支阻塞敏感而特异的指标,而ST段抬高Ⅱ/Ⅲ<1、Ⅰ导联ST段压低则对诊断右冠状动脉阻塞具有很高的特异性和敏感性。

Objective To explore electrocardiographic diagnose values for infarct-related artery in inferior wall acute myocardial infarction IWAMI Methods We studied and compared results of electrocardiographic examination and coronary angiography in 61 patients with IWAMI, to inspect relationship between infarct-related artery and ratio of ST elevation in lead Ⅱ/Ⅲ and ST deviation in lead Ⅰ. Results In 14 patients with occlusion of left circumflex coronary artery LCCA, 12 patients with ST elevation in lead Ⅱ/Ⅲ≥1, and 2 patients with ST elevation in lead Ⅱ/Ⅲ<1, 12 patients with ST elevation or with an isoelectric ST segment in lead Ⅰ and 2 patients with ST depression in lead Ⅰ. Whereas in 47 patients with occlusion of right coronary artery RCA, 2 cases with ST elevation in lead Ⅱ/Ⅲ≥1 and 45 patients with ST elevation in lead Ⅱ/Ⅲ<1, 2 patients with ST elevation or with an isoelectric ST segment in lead Ⅰand 45 patients with ST depression in lead Ⅰ. Difference between two groups were statistically significant. Conclusion ST elevation in lead Ⅱ/Ⅲ≥1 and an isoelectric or elevated ST segment in lead Ⅰ are sensitive and specific markers of LCCA occlusion, whereas ST elevation in lead Ⅱ/Ⅲ<1 and ST depression in lead Ⅰ are sensitive and specific markers of RCA occlusion.