不稳定性心绞痛62例心电图缺血性改变与冠状动脉造影结果的对比研究

目的：观察不稳定性心绞痛(UAP)患者胸痛时心电图(ECG)改变对UAP缺血相关血管判别的可能性。方法：记录62例UAP患者入院时、胸痛发作时、发作后12导联ECG(必要时18导联)；所有患者均以Judkins技术经股动脉行冠脉造影；对比分析UAP胸痛时ECG动态缺血性ST—T变化与冠状动脉造影结果。结果：62例UAP患者胸痛发作时ECG呈T波伪改善6例；T波倒置5例；ST段一过性抬高4例；动态缺血性ST段压低47例。ECG定位为前壁、下壁、侧壁、广泛心肌缺血者分别为30、8、11、13例。前壁心肌缺血预测左前降支(IAD)病变的诊断符合率为86．7％；下壁心肌缺血预测右冠状动脉(RCA)病变的诊断符合率为62．5％；侧壁心肌缺血预测左回旋支(LCX)病变的诊断符合率为54．5％；广泛心肌缺血判定左主干(LMCA)病变的诊断符合率为61．5％。结论：UAP患者胸痛时ECG动态缺血性改变多样，心肌缺血ECG定位可以用作初步判定UAP缺血相关动脉。

Study on the Relationship between Electrocardiogram and Coronary Angiograms in 62 Patients with Unstable Angina

Objective: To investigate the predictive value of EGG in defining the culprit coronary artery in patients (pts) with unstable angina pectoral (UAP). Methods: Standard 12 leads EGG (18 leads EGG if necessary) were recorded in 62 hospitalized patients with UAP during chest pain. Coronary angiography of all patients was performed via femoral artery to define the culprit vessel using the Judkins technique. The relationship between changes of EGG and angiograms in UAP has contrasted. Results: T wave tentative normalization in EGG was found in 6 pts, T wave inversion in 5 pts, transient elevation of ST segment in 4 pts. There were 47 pts with dynamic depression of ST segment, and anterior, inferior, lateral and extensive myocardial ischemia in 30, 8, 11, and 13 pts respectively according to the orientation of EGG. The tally rate between anterior myocardial ischemia and focus of left anterior descending coronary artery (LAD) was 86. 7%. The tally rate between inferior myocardial ischemia and focus of right coronary artery (RCA) was 62. 5%. The tally rate between lateral myocardial ischemia and focus of left circumflex coronary artery (LCX) was 54. 5%. The tally rate between extensive depression of ST segment and focus of left main coronary artery (LMCA) was 61. 5%. Conclusion: The dynamic alteration of ST segment or T wave in pts with unstable angina was variant. It was feasible to define ischemia-related artery with alteration of ST segment or T wave orientation in EGG.