急性下壁心肌梗死胸前导联ST段压低与冠状动脉病变的关系及临床意义探讨

目的 :探讨急性下壁心肌梗死胸前导联ST段压低与冠状动脉病变的关系及临床意义。方法 :回顾分析 2 0 0 0年 7月至 2 0 0 2年 5月住院的首次急性下壁心肌梗死患者 6 0例。按胸前导联ST段压低范围将患者分为 4组 :无胸前导联ST段压低组 (Ⅰ组 ,n =2 2 ) ;胸前导联V1～ 3ST段压低组 (Ⅱ组 ,n =12 ) ;胸前导联V4～ 6 ST段压低组 (Ⅲ组 ,n =12 ) ;胸前导联V1～ 6 ST段压低组 (Ⅳ组 ,n =14 )。分析内容包括冠心病危险因素、心电图、心肌酶谱、心脏彩超、冠状动脉造影以及心肌梗死的并发症。结果 :左前降支 (LAD)病变发生率在Ⅰ与Ⅲ、Ⅳ各组分别为 4 7 1%、6 0 %、72 7% (P >0 0 5 ) ,而在Ⅱ组仅为 9 1% ,与Ⅰ组比较 ,Ⅱ组的LAD病变发生率低 (P <0 0 5 ) ,但Ⅰ组LAD病变程度较轻 ,>90 %狭窄者仅占 12 5 % ,而Ⅲ、Ⅳ组分别占 83 3%、87 5 % (P <0 0 5 ) ;回旋支 (LCX)病变在Ⅰ、Ⅱ、Ⅲ、Ⅳ组分别占 17 6 %、4 5 5 %、6 0 %、6 3 6 % ,与Ⅰ组比较 ,Ⅲ、Ⅳ各组的LCX病变发生率较高 (P <0 0 5 ) ,且Ⅳ组多支病变比例较高 (P <0 0 5 ) ;左室射血分数 (LVEF)在Ⅰ、Ⅱ、Ⅲ、Ⅳ组分别为 0 6 3± 0 0 5、0 6 2± 0 0 6、0 5 5± 0 10、0 5 1± 0 13,与Ⅰ组相比 ,Ⅳ组的LVEF较低 (P <0 0 5 ) ;低血压状?

Relation between precordial ST segment depression and coronary lesion characteristic and its clinical implication in patients with acute inferior myocardial infarction

Objective:To investigate the relationship between coronary lesion characteristics and precordial ST segment depression and its clinical implication in patients with acute inferior myocardial infarction.Method:Sixty patients with first acute inferior myocardial infarction were divided into four groups on the basis of admission electrocardiogram.Group Ⅰ:patients with no precordial ST segment depression( n= 22),Group Ⅱ:those with St segment depression in leads v\-1 to v\-3( n= 12),Group Ⅲ:those with ST segment depression in leads v\-4 to v\-6( n= 12) and Group Ⅳ:those with ST segment depression in leads v\-1 to v\-6( n= 14).Data including history,ECG,myocardial enzymes,echocardiogram,coronary angiograms and postinfarction complications were analyzed.Result:The patients in Group Ⅱ had less LAD lesion than those in group Ⅰ(9.1% VS 47.1% P <0 05).Although similar frequence of LAD lesion in group Ⅰ,Ⅲ and Ⅳ,the patients with LAD stenosis more than 90% accounted for only 12.5% in goup Ⅰ but 83 3%,87 5% in group Ⅲ,Ⅳrespectively( P <0 05).compared with those in group Ⅰ,Those in group Ⅲ and Ⅳ had more LCX lesion,the patients in group Ⅳ had more multivessel involvement,lower LVEF and more hypotension condition.Conclusion:The precordial ST segment depression in v\-1 to v\-3 in patients with acute inferior myocardial infarction suggests lover incidence of LAD lesion,whereas the cause of ST segment depression in v\-4 to v\-6 or v\-1 to v\-6 may be due to extensive myocardial ischemia caused by severe stenosis of LAD and/or LCX.Patients with widespred precordial ST segment depression had higher incidence of hypotension and heart failure,more attention should be payed to these subgroup of patients.