aVR导联对前壁心肌梗死相关血管定位的作用

目的通过与冠状动脉造影（CAG）对比，研究aVR导联ST段改变的特征。对急性前壁心肌梗死（AAMI）的梗死相关动脉（IRA）阻塞部位的定位。方法对比89例急性前壁心肌梗死病人．其中左前降支近段（PS）闭塞43例、左前降支远段（DS）闭塞46例，胸痛发作12h内的心电图。结果两组胸导联的ST段抬高无明显差异，PS组aVR导联ST段抬高较明显（0．94±0．48mmvs0．30±0．56mm．p=0．021）：PS组Ⅱ、Ⅲ、aVF导联ST段压低较显著（分别为-1．21±0．72mm vs S-0．64±0．53mm。p=0．010；-1．63±0．92mmvs-0．98＋0．39mm．／9=0．016；-1．40±0．66mm vs -0．85±0．32mm，／9=0．000）。在胸导联ST段抬高的同时．aVR导联ST段抬高预测左前降支（LAD）近段闭塞的敏感性（Se）、特异性（Sp）、符合率（CR）、阳性预测值（PPV）、阴性预测值（NPV）分别为60．47％、93．48％、77．53％、89．66％、71．67％。结论在胸导联ST段抬高的同时合并aVR导联ST段抬高和／或下壁导联的ST段压低，可预测左前降支近段闭塞。

The value of lead aVR to predict the occlusion site of culprit vessel in the acute anterior myocardial in-farction

Objective To predict the patients infarct-related artery （IRA） site in acute anterior myocardial infarction（AhMl） with lead aVR. Methods All admitted patients underwent conventional electrocardiogram （ECG） and coronary angiography within 10 days . Among 89 patients who were diagnosed of AAMI, occlusion proximal to LAD was presented in 43 patients and distal to LAD in 46 patients. ECG was registered within 12 hours after the acute episode, and was compared with the CAG. Results When compared the ECG of PS and DS, There was no significant marked ST segment elevation in precordial leads, however, there were significant changes of ST ↑aVR and ST↓, Ⅱ ,Ⅲ,aVF in PS patients （0.94±0.48mm VS 0.30±0.56mm, p=0.021 ;-1.21±0.72mm VS -0.64±0.53mm, p=0.010;-1.63±0.92mm VS -0.98±0.39mm,p=0.016;-1.40±0.66mm VS -0.85±0.32mm,p=0.000）. Coexist of marked ST ↑ in precordial leads, the sensitivity（Se） ,specificity（Sp）,coincidence rate（CR）,positive predictive value（PPV） ,negative predictive value（NPV） of ST ↑ aVR as predictor of the proximal to the LAD occlusion was 47% ,93.48% ,77.53% ,89.66% ,71.67% respectively. Conclusion Coexist of ST ↑ in precordiol leads, ST ↑ aVR and/or ST ↓ in inferior leads were useful for predicting proximal to LAD occlusion .