冠状动脉前降支闭塞致急性心肌梗死的心电图ST段偏移特点分析

目的探讨冠状动脉前降支(LAD)单支闭塞所致急性心肌梗死(AMI)的心电图(ECG)特点。方法回顾性分析51例LAD急性闭塞所致AMI患者心电图ST段改变与冠状动脉造影结果。结果 V_2导联ST段抬高<0.2 mV预测LAD远段闭塞敏感度为52.9%,特异度为88.2%,在胸导联ST段抬高的情况下,特异度增高(96.2%)。V_6导联ST段压低预测LAD近段闭塞敏感度为26.5%,特异度100%,在胸导联ST段抬高的情况下,V_1导联ST段抬高≥0.2 mV预测LAD近段闭塞敏感度53.8%,特异度88.9%。下壁导联Ⅱ、Ⅲ、aVF ST段压低预测LAD近段闭塞特异度较高,Ⅲ、aVF导联组合较Ⅱ、Ⅲ、aVF导联组合判断LAD近段闭塞特异度及阳性预测值高。结论 V_1导联ST段抬高、V_6导联ST段压低、下壁导联ST段压低有助于判断LAD近段闭塞,V_2导联ST段抬高<0.2 mV有助于判断LAD远段闭塞。

Analysis of electrocardiogram ST segment changes in patients with acute single left anterior descending artery obstruction

Objective To investigate electrocardiogram （ECG） ST segment changes in patients with acute single left anterior descending artery （LAD） obstruction. Methods A total of 51 patients with acute single LAD obstruction confirmed by coronary angiography were enrolled in this retrospective study. The ECG ST segment changes of each patient were recorded and reviewed. Results The sensitivity and specificity of ST V2 elevation less than 0. 2 mV in predicting distal LAD （DD） obstruction were 52.9% and 88.2% respectively, and the specificity was increased to 96. 2% if ST segment elevation was presented in other precordial leads. The sensitivity and specificity of ST segment depression in Lead V6 in predicting proximal LAD （PD） obstruction were 26. 5% and 100% respectively. The sensitivity and specificity of ST V1 elevation more than 0. 2 mV in predicting PD obstruction was 53.8% and 88.9%. The specificity and positive predictive value of Leads Ⅲ and aVF in predicting PD obstruction were higher than those of combination of lead Ⅱ , lead Ⅲ and lead aVF. Conclusion ST V1 elevation, ST V6 depression and ST segment depression in Leads Ⅱ , Ⅲ ,aVF may suggest PD obstruction. ST V2 elevation less than 0. 2 mV may suggest DD obstruction.