aVR导联ST段抬高对非ST段抬高型急性心肌梗死的意义

目的：探讨aVR导联ST段抬高（ ST segment elevation ，STSE）对于非STSE型急性心肌梗死（ acute myocardial infarction ， AMI ）的预测价值。方法回顾性分析425例非STSE 型AMI患者的心电图资料，并观察各导联ST段压低情况及是否存在T波倒置。对所测定数据进行整理和统计学处理。结果 aVR导联STSE多见于完全性右束支阻滞、左心室肥厚以及V1导联STSE的患者，在其他导联广泛ST段压低的患者中也较为多见；此类情况在T波倒置患者中较少见。本研究中，22例在住院时死亡，其中5例死于心源性休克。患者住院死亡率的不断升高和aVR导联STSE的等级不断上升相关。多重变量分析表明，aVR导联STSE已经成为预测住院死亡的独立重要变量。 aVR导联STSE大都与住院患者的心肌缺血时间以及发生心力衰竭相关，但是与血清肌酸激酶或肌酸激酶同工酶 MB 的水平高低没有相关性。结论如果aVR导联STSE和严重冠状动脉病变之间的联系，能够在大样本非STSE型AMI患者群体中得到进一步验证，那么aVR导联STSE就可以成为选择早期介入治疗患者的一个较为有用的指标。

Predictive value of ST segment elevation in aVR lead for non-ST-segment-elevation acute myocardial infarction

Objective To study the predictive value of ST segment elevation （ STSE ） in aVR lead for non-STSE acute myocardial infarction （ AMI） .Methods The ECG data of 425 patients with non-STSE AMI were retrospectively analyzed , with ST depression in each lead and T-wave inversion observed .All the measured data were sorted out and statistically analyzed .Results STSE in aVR lead was more common in complete right bundle branch block , left ventricular hypertrophy and patients with STSE in V1 lead.And it is also popular in the patients with ST segment depression in oth-er leads while it is rarely seen in the patients with T-wave inversion .In our study , 22 patients died during hospitalization , among whom 5 cases died of cardiogenic shock .The continuous increase of inhospital mortality was related to the ceaseless rise of STSE levels in aVR lead .Multivariate analy-sis showed that STSE in aVR lead had become an important independent variable for predicting inhos -pital mortality .STSE in aVR lead was mostly associated with inpatient＇s duration of myocardial ische-mia and heart failure , but was not related to levels of serum CK or CK-MB.Conclusion If the rela-tionship between STSE in aVR lead and serious coronary artery disease can be verified in a large sample of non-STSE AMI patients , STSE in aVR lead can serve as a quite useful index in judging which patient is feasible for interventional therapy in an early phase .