急性心肌梗死时体表心电图对梗死相关动脉的判断

目的了解急性心肌梗死(AMI)的体表心电图对心肌梗死相关动脉(IRA)及其闭塞位置判断作用.方法对264例急性心肌梗死患者的心电图和冠状动脉造影资料进行回顾性对比分析.结果①下壁AMI时血管闭塞发生在右冠状动脉(RCA)74例(78.7%),左回旋支(LCX)20例(21.3%).Ⅰ、aVL导联ST段压低提示RCA为IRA的敏感性,特异性和阳性预测值分别为94.6%,70%和92.1%.ST段压低Ⅰ＜aVL提示RCA为IRA的敏感性,特异性和阳性预测值分别为83.8%,90%和96.9%.ST段抬高Ⅱ＜Ⅲ提示RCA为IRA的敏感性,特异性和阳性预测值分别为90.5%,90%和97.1%.ST段压低Ⅰ＜aVL和ST段抬高Ⅱ＜Ⅲ提示RCA为IRA的敏感性,特异性和阳性预测值分别为81.8%,100%和100%.非ST段压低Ⅰ＜aVL和非ST段抬高Ⅱ＜Ⅲ提示LCX为IRA的敏感性,特异性和阳性预测值分别为85%,100%和100%.13例合并右室心梗IRA均为RCA.②前间壁AMI时STⅠ、STaVL抬高,STⅡ、Ⅲ、aVF下降均不能提示IRA为LAD或RCA(P分别大于0.05).③前壁AMI时STⅠ、STaVL抬高,STⅡ、Ⅲ、aVF下降判断LAD近段闭塞的敏感性、特异性和阳性预测值分别为70.4%,59.3%,87%,95.7%和86.4%,94.1%.④广泛前壁AMI时STⅠ、STaVL抬高,STⅡ、Ⅲ、aVF下降判断LAD近段闭塞的敏感性、特异性和阳性预测值分别为100%,95.5%,85.7%,100%和97.8%,100%.结论下壁、前壁和广泛前壁AMI时体表心电图对心肌梗死相关动脉(IRA)及其闭塞位置判断具有预测价值.     

AMI伴对应性ST段压低的核素心血池显像观察

急性心肌梗塞(AMI)时对应性ST段压低是指下壁梗塞时前壁心电图导联(V_1～V_6、aVL)有ST段压低,或前壁梗塞时下壁导联(Ⅱ、Ⅲ、aVF)有ST段压低。若急性前壁梗塞伴两个以上下壁导联ST段压低≥0.1mm     

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。     

aVR导联对急性下壁心肌梗死患者梗死相关血管判断的价值

目的探讨心电图(ECG)对急性下壁心肌梗死(MI)患者梗死相关血管(IRA)判断的价值。方法选择2002年7月～2004年12月的急性下壁MI患者90例,回顾性分析其症状发作后24h内ECG改变。结果90例中,IRA为右冠状动脉(RCA)者70例,为左回旋支(LCX者)20例;Ⅰ导联ST段抬高和(或)V1和V2导联ST段压低提示IRA在LCX,而ST段抬高Ⅲ导联大于Ⅱ导联和(或)导联V4RST段抬高≥0.5mm提示IRA在RCA;aVR导联ST段压低≥1mm判断IRA为LCX,其敏感性为70.0%,特异性为94.3%。结论Ⅰ导联ST段抬高、ST段抬高Ⅲ导联>Ⅱ导联、导联V4RST段抬高≥0.5mm、V1和V2导联ST段抬高或压低以及aVR导联ST段压低等5项标准可用于判断急性下壁MI患者的IRA,而aVR导联ST段压低为一项新的标准。     

心电图ST段改变判断急性下壁心肌梗死患者梗死相关血管的意义

目的探讨急性下壁心肌梗死时心电图ST段改变对心肌梗死梗死相关动血管(IRA)的判断价值。方法通过对84例急性下壁心肌梗死的患者的心电图Ⅰ、aVL、Ⅱ、Ⅲ、aVR、V5、V6导联ST段偏移进行分析,并与冠状动脉造影结果进行对比。结果 (1)IRA为右冠状动脉(RCA)68例,左冠状动脉回旋支(LCX)16例。(2)ST↑ⅢST↑Ⅱ提示IRA为RCA的敏感性是93%,特异性是94%,阳性预测值(PPV)是98%,阴性预测值(NPV)是79%;ST↑ⅢST↑Ⅱ提示IRA为LCX的敏感性是81%,特异性是97%,PPV是87%,NPV是96%。(3)ST↓V3/ST↑Ⅲ的值0.5提示IRA为RCA的敏感性是90%,特异性是94%,PPV是98%,NPV是68%;ST↓V3/ST↑Ⅲ的值1.2提示IRA为LCX的敏感性是81%,特异性是97%,PPV是87%,NPV是97%。(4)ST↓aVLST↓I提示IRA为RCA的敏感性是91%,特异性是81%,PPV是95%,NPV是68%。(5)aVR导联ST段压低提示IRA为RCA的敏感性是88%,特异性是87%,PPV是97%,NPV是64%;aVR导联ST段抬高提示IRA为LCX的敏感性是81%,特异性是94%,PPV是76%,NPV是95%。(6)Ⅱ、Ⅲ、aVF导联ST段抬高伴V5、V6导联ST段抬高对梗死相关血管为RCA或LCX无预测价值。结论常规12导联心电图ST段偏移对判断急性下壁心肌梗死梗死相关血管有重要的预测价值。     

下壁急性心肌梗死患者心电图对梗死相关动脉定位的再评价

目的探讨ST段抬高型下壁急性心肌梗死(AMI)患者心电图对梗死相关动脉(IRA)定位的价值。方法分析76例ST段抬高型急性下壁心肌梗死患者心电图改变并与冠状动脉造影结果进行回顾性对比分析。结果①梗死相关动脉多为右冠状动脉(RCA),其次为左回旋支(LCX),分别为56例(73.7%)、20例(26.3%)。②患者心电图STⅢ↑/STⅡ↑>1、STaVL↓/STI↓>1对判断梗死相关动脉在RCA敏感性分别为87.5%、96.4%,特异性分别为85.0%、85.0%。STV3↓/STⅢ↑>1.2对判断梗死相关动脉为LCX的特异性为94.6%。③心电图STaVF↑+STV2↓>0对于判断梗死相关动脉为RCA的特异性、阳性预测值分别为90.0%、95.8%。④心电图V1～V3导联ST段压低之和与下壁导联ST段抬高之和的比值ST(V1～V3)↓/ST(inf)↑≤0.5对于判断相关动脉为RCA的敏感性、阳性预测值分别为78.6%、91.7%。⑤心电图STV3↓/STⅢ↑≤0与心电图STV1↑预测梗死动脉在RCA近端的敏感性分别为54.5%、86.4%,特异性分别为29.4%、88.2%。结论心电图STⅢ↑/STⅡ↑>1、STaVL↓/STI↓>1,STV3↓/STⅢ↑>1.2,STaVR↓≥0.05 mV预测IRA为RCA或LCX特异性较高;STV1↑预测IRA为RCA近段的敏感性、特异性较高;而STV3↓/STⅢ↑≤0预测RCA近段闭塞结果不理想。     

急性下壁心肌梗死ST段改变特征的分析

目的结合冠状动脉造影结果,分析急性下壁心肌梗死患者心电图ST段改变的特征,探讨梗死相关动脉(IRA)的判定。方法选择197例急性下壁心肌梗死,其中右冠状动脉近段闭塞69例、右冠状动脉远段闭塞80例、回旋支(LCX)闭塞48例,患者胸痛发作12h内的心电图。结果三组以及导联间比较,右冠状动脉(RCA)闭塞可出现STaVR压低(p<0.05),同时STⅢ↑>STⅡ↑(p<0.05),STaVL压低较STI明显(p<0.05),与RCA闭塞的部位无关。结合三者,其预测RCA闭塞的敏感性84%、特异性90%、阳性预测值96%、阴性预测值60%。结论急性下壁心肌梗死早期除下壁导联ST抬高外,STⅢ↑>STⅡ↑、STaVL↓>STⅠ↓、STaVR↓提示RCA阻塞,是区别RCA闭塞或LCX闭塞的关键指标,对预后和决定是否采取血管重建治疗具有重要的参考价值。     

前壁急性心肌梗死时下壁ST段压低的意义

目的 :前瞻性研究前壁急性心肌梗死 ( AMI)病人下壁 ST段压低的意义。方法 :连续评价前壁 AMI病人 ,选择病人就诊头 3h心电图 ( ECG)测量其 ST段水平 ,并于住院第 10～ 2 1天行冠状动脉造影 ( CAG) ,评估左冠前降支 ( L AD)梗塞相关病变与第一对角支 ( D1)开口的位置关系。结果 :入选 85例中 2例 CAG阴性。余 83例分两组 ,A组为 LAD病变在 D1开口前或 D1开口后但合并 D1病变 ( 63例 ) ,B组为 D1开口后但不合并 D1病变 ( 2 0例 )。83例中 、 、a VF导联 ST段压低≥ 1mm者分别为 2 7、38、38例。以 、a VF导联 ST段压低≥ 1mm预测 A组病变的阳性预测值分别为92 .1%和 89.5 % ( P <0 .0 5 )。结论 :前壁 AMI时下壁 ST段压低提示 LAD近端病变或 LAD远端病变合并 D1病变。     

急性下壁心肌梗死患者心电图胸前导联ST段改变的临床意义

目的探讨急性下壁心肌梗死患者心电图胸前导联ST段改变与冠状动脉造影(CAG)所见冠状动脉病变部位的关系及其临床意义。方法 187例急性下壁心肌梗死患者,按入院时18导心电图胸前导联ST段改变分为3组,ST段无变化组(47例),ST段抬高组(16例),ST段压低组(124例);所有患者均行CAG。结果急性下壁心肌梗死伴胸前导联ST段抬高时多为右冠状动脉(RCA)近段闭塞(14例,82.3%),尤其是伴圆锥支动脉闭塞,与RCA中远端闭塞(2例,5.9%)比较差异有统计学意义(P0.01),且14例(73.7%)伴有右心功能不全和血流动力学障碍。下壁心肌梗死胸前导联ST段压低者可见于RCA、回旋支(LCX)闭塞及RCA、LCX闭塞与前降支(LAD)、对角支(D)病变的不同组合,其中LCX闭塞伴RCA病变者多表现为朐前ST V_4～V_6的压低,RCA闭塞伴LAD近端病变多有胸前ST V_1～V_6的压低,RCA伴D病变胸前ST V_1～V_3压低,与对照组比较差异有统计学意义(P0.05)。结论急性下壁心肌梗死合并胸前导联ST段抬高表明为RCA近段或丌口闭塞且多伴右心室心肌梗死和心功能不全;下壁心肌梗死伴胸前导联ST段压低提示为多支病变,ST V_1～V_3压低多伴有对角支严重狭窄,STV_1～V_6压低多伴有前降支的严重狭窄。     

aVR导联对急性下壁心肌梗死罪犯血管的预测价值

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下壁心肌梗死的相关动脉定位的意义。方法对比65例急性心肌梗死，其中右冠状动脉近段闭塞26例、右冠状动脉远段闭塞29例、左叫旋支（LCX）闭塞10例，分析在病人胸痛发作12h内的心电图变化。结果三组病人下壁导联的ST段抬高差异无统计学意义，伴aVR导联ST段压低，提示右冠状动脉（RCA）闭塞，如不伴aVR导!联卯段膻低，则提示LCX闭塞，右冠状动脉近段闭寒，不影响胸前导联ST段，心电图指标阳性预测值96．7％；右冠状动脉远段闭塞则构成V1～V3导联ST段压低，阳性预测值83％；LCX闭塞虽不影响aVR导联卯段，但构成V1～V3导联ST段压低，阳性预测值87％。结论急性下壁心肌梗死早期除下壁导联ST段抬高外，是否合并aVR导联ST段压低，是区别RCA闭塞或LCX闭塞的关键指标。对预后和决定是否采取血管厦建治疗具有重要的参考价值。     

心电图诊断急性下壁，前壁心肌梗塞相关动脉的价值

目的：分析急性下壁、前壁心肌梗塞患者心电图表现及梗塞相关动脉的分布特点,评价心电图诊断急性下壁、前壁心肌梗塞相关动脉的价值。方法：对26例急性下壁心肌梗塞、29例急性前壁心肌梗塞患者的心电图和冠状动脉造影资料进行回顾性比较分析。结果：急性下壁心肌梗塞（26例）的梗塞相关动脉为右冠状动脉（RCA）者19例（73％）。回旋支（LCX）6例（23％）;急性前壁心肌梗塞（29例）的梗塞相关动脉为前降支（LAD）者26例（90％）;下壁心肌梗塞相关动脉为RCA的19例中Ⅱ、Ⅲ,aVF导联ST段上移18例（94％）,STⅢ↑／STⅡ↑〉1者16例（84%）。结论：急性下壁、前壁心肌梗塞的心电图表现与梗塞相关动脉有关,有较高的临床诊断价值。     

心电图对老年急性下壁心肌梗死冠状动脉病变部位的预测价值

目的　探讨急性下壁心肌梗死心电图与冠状动脉病变的关系 ,以揭示体表心电图对梗死相关动脉及病变节段的预测价值。方法　对 15 6例老年急性下壁心肌梗死患者的体表心电图和冠状动脉造影资料进行对比分析。结果　梗死相关动脉为右冠状动脉占 79.5 % ,左回旋支占 2 0 .5 %。单纯急性下壁心肌梗死病变节段多发生在第一右心室支开口以远 (77.6 % ) ,合并右心室心肌梗死病变节段多发生在第一右心室支开口前 (87% )。STⅢ 抬高 /STⅡ 抬高 >1,STⅠ、aVL下移≥ 1mm ,提示右冠状动脉为梗死相关动脉的敏感性分别为 87.9%、89.5 % ,特异性分别为 84 .4 %、81.2 % ,阳性预告值分别为 95 .6 %、94 .8% ,两者差异无显著性意义 (P >0 .0 5 )。ST段V1、V2 下移≥ 1mm ,提示左回旋支为梗死相关动脉的敏感性 ,特异性和阳性预告值分别为 84 .4 %、91.9%、73.0 %。结论　急性下壁心肌梗死时心电图对判断梗死相关动脉及病变节段有重要的预测价值     

心电图对急性下壁心肌梗死患者梗死相关血管及闭塞部位的预测价值

目的:探讨急性下壁心肌梗死患者的体表心电图对梗死相关血管及闭塞部位的预测价值。方法:对62例急性下壁心肌梗死患者的体表心电图和冠状动脉造影资料进行回顾性对比分析。结果:梗死相关血管为右冠状动脉者50例(80.65%),左回旋支者12例(19.35%)。单纯急性下壁心肌梗死多发生在右冠状动脉中远段(62.07%);并发右室梗死者均发生在右冠状动脉,且多发生在右冠状动脉近段(70.00%)。STⅢ抬高/STⅡ抬高>1、STaVL压低≥0.5mm、STV1抬高≥0.5mm、STV3压低/STⅢ抬高≤1.2提示梗死相关血管为右冠状动脉的灵敏度分别为88.00%、90.00%、66.00%、72.00%,特异度分别为58.33%、75.00%、83.33%、66.67%。STⅢ抬高/STⅡ抬高≤1、STaVL呈等电位线或抬高、STV1压低≥0.5mm、STV3压低/STⅢ抬高>1.2提示梗死相关血管为左回旋支的灵敏度分别为58.33%、75.00%、66.67%、66.67%,特异度分别为88.00%、90.00%、80.00%、72.00%。结论:急性下壁心肌梗死时,体表心电图对梗死相关血管及闭塞部位有重要的预测价值。     

心电图改变对急性下壁心肌梗死相关血管的预测价值

目的:对急性下壁心肌梗死患者的心电图资料进行回顾性研究,分析和比较心电图改变与冠状动脉造影及临床特点的对应性关系。探讨体表心电图改变对急性下壁心肌梗死患者的临床价值。方法:选取86例急性下壁心肌梗死患者,根据冠状动脉造影结果分为右冠状动脉(RCA)病变组和左冠状动脉(LCA)病变组。对比分析其心电图改变与冠状动脉造影结果及临床特点。结果:Ⅰ、Ⅱ、Ⅲ、aVR导联ST段及aVL导联波形改变对诊断梗死相关血管具有重要价值;V3与Ⅲ导联ST段改变比值预测梗死相关血管部位具有重要价值;伴aVR导联ST段压低患者病情重;伴胸前导联ST段压低者病情重、并发症发生率明显增高。结论:心电图对诊断下壁急性心肌梗死相关血管及其临床特点具有重要的预测价值。     

心电图在诊断急性心肌梗死相关动脉中的价值

目的分析急性心肌梗死患者不同梗死部位心电图表现及梗死相关动脉的分布特点,评价心电图诊断梗死相关动脉的价值。方法对132例急性心肌梗死患者心电图和冠状动脉造影资料进行回顾性比较分析。结果心电图显示心肌梗死发生率以心脏下壁、前间壁和广泛前壁最高,分别为31例(23.5%)、26例(19.7%)和22例(16.7%);造影显示梗死相关动脉的发生率分别为左主干(LM)3例(2.3%)、前降支(LAD)73例(55.3%)、回旋支(LCX)18例(13.6%)、右冠状动脉(RCA)38例(28.8%);前壁心肌梗死(55例)的梗死相关动脉多为LAD(51例,92.7%),下壁心肌梗死(31例)的梗死相关动脉多为RCA(22例,71.0%)或LCX(7例,22.6%),且与冠状动脉优势类型密切相关,前壁梗死合并aVR、aVL导联ST段抬高对诊断LAD近段闭塞的特异性较高,分别为86.7%和90.0%。结论急性心肌梗死心电图表现与梗死相关动脉存在明显相关性,有较高的临床诊断价值。     

Electrocardiographic identification of the infarct-related artery in acute inferior myocardial infarction.

INTRODUCTION: Mortality and morbidity from acute inferior myocardial infarction (MI) are determined, among other factors, by the infarct-related artery (IRA). Several electrocardiographic (ECG) criteria have been proposed to differentiate between the right coronary artery (RCA) and the left circumflex coronary artery (LCx) as the IRA in inferior MI. Recently, a new criterion has been proposed (ST segment depression in lead aVR). It was our objective to evaluate the old and the new ECG criteria in identifying the IRA in patients with inferior MI. METHODS: Patients with inferior MI treated by primary angioplasty were included, following evaluation of the admission ECG. Patients with a previous history of Q-wave myocardial infarction and complete bundle branch block were excluded. The artery with the most severe lesion was considered the IRA. The following ECG criteria were assessed: ST depression in lead DI; ST depression in leads V1 and V2, ST elevation in lead DIII > DII, ST depression in V3/ST elevation in DIII ratio > 1.2 (classical criteria) and ST depression in lead aVR. ST-segment elevation or depression was measured 0.06 sec after the J point. RESULTS: 53 patients were included (mean age 59.1 +/- 13.9 years, 38 males). The RCA was the IRA in 38 patients and the LCx in 15. Baseline characteristics (age, gender, TIMI flow, Killip class, and pain-to-balloon time) were similar in both groups. All the classical criteria were able to identify the IRA. The new criterion--ST depression in lead aVR--identified the IRA in a small number of patients (sensitivity 33%, specificity 71%, p = NS). CONCLUSIONS: The 4 classical criteria were useful in identifying the IRA in patients with inferior MI. ST depression in lead aVR (a recently proposed new criterion), on the other hand, showed limited utility in differentiating between RCA and LCx.     

心电图对急性下壁心肌梗塞时梗塞相关动脉的识别

对33例急性下壁心肌梗塞患者入院时心电图与3周内冠脉造影对照,以发现梗死相关动脉(IRA)识别方法.23例IRA为无左回旋支(LCX)狭窄的右冠状动脉(RCA)病变组V_(1-4)ST段压低16例(70%),7例无RCA狭窄的LCX病变组V_(1-4)ST段压低5例(71%),二组无显著差异;ST_Ⅱ抬高>ST_Ⅰ在RCA组15例(65%),而LCX组无1例(0%),二组有显著差异;ST_(avL)压低>ST_ⅠRCA组16例(70%)、LCX组3例(43%),二组无显著差异.RCA组V_(7-9)ST段抬高2例(9%),LCX组为5例(71%),二组差异显著,RCA组V_(4R)抬高9例(3%),LCX组无1例(0%),二组有显著差异.本文提示:ST_Ⅱ抬高>ST_Ⅰ、V_(7-9)和V_(4R)ST段抬高对急性下壁心梗时IRA识别有一定临床价值.     

Electrocardiograms during acute occlusion of the left circumflex artery as compared with that of the right coronary artery

To assess the characteristic electrocardiographic (ECG) ST changes during acute occlusion of the left circumflex artery (LCX), we observed ECG changes during percutaneous transluminal coronary angioplasty (PTCA) of the LCX and compared the results with those obtained during right coronary angioplasty. Results were as follows: 1. In the 30 patients who had LCX angioplasty (group LCX), ST-segment elevation occurred most frequently in lead V6 (67.7%) and in lead III (46.7%), but rarely in leads and aVL. ST depression occurred most frequently in lead V3 (80.0%) and in lead V2 (73.3%), but rarely in other leads except for leads I and aVL (23.3%, 33.3%). 2. Four types of ST change in lead combinations were observed. These included: (1) ST elevation in the inferior leads (II, III and aVF), (2) ST elevation in the lateral leads (V5 and V6), (3) ST depression in the anterior leads (V2-V4) and (4) ST depression in the high lateral leads (I and aVL). In group LCX, nine cases (30.0%) manifested all four changes, and six cases (20.0%) revealed only ST depression in the anterior leads without ST changes in other leads. 3. ST depression in the anterior leads and ST elevation in the inferior and lateral leads were observed in nearly equal frequency in patients who received PTCA at the proximal site (Seg. 11) and at the distal site (Seg. 13) in the group LCX. However, ST depression in the high-lateral leads was more frequently observed in the distal than in the proximal cases (66.7% vs 33.3%).(ABSTRACT TRUNCATED AT 400 WORDS)     

Differentiating the infarct-related artery on initial electrocardiogram in single or multi-vessel disease in acute inferior myocardial infarction and evaluating involvement of vessels using correspondence analysis

Initial electrocardiography changes were compared prospectively with the findings of coronary angiography to predict the infarct-related artery (IRA) in cases of single- and multi-vessel disease and to demonstrate the relationship between other coexisting coronary involvements and IRA in patients who presented with acute inferior myocardial infarction (AMI). ST elevations or depressions of at least 1 mm (0.1 mV) were evaluated in the leads I, aVL, and V1-V6. Of the 160 patients hospitalized due to inferior AMI, 153 (96%) underwent coronary angiography using standard methods. The angiograms were screened for stenotic lesions using quantitative coronary angiography to confirm significance, which was considered >50% vessel lumen diameter reduction. Among single-vessel involvements, the IRA was either the circumflex artery (Cx) or right coronary artery (RCA). In conditions in which IRA was detected as either Cx or RCA, 1-, 2-, and 3-vessel involvements were also detected. Correspondence analysis was performed to show the vessel involvements accompanying IRA. Compared with patients with IRA as RCA, the presence of ST depressions in the leads V1 or V2 and aVL were more frequently seen in patients with IRA as Cx (p=0.000, p=0.015, respectively). Among all vessel involvements in which IRA was either Cx or RCA, a ST-segment depression in leads V1 or V2 (p=0.000) and aVL (p=0.000) and a ST-segment elevation in lead I (p=0.005) were considered to be significant for Cx, and a ST-segment depression in lead I for RCA involvement (p=0.010). According to correspondence analysis, the most frequent single-vessel involvement seen in inferior AMI was RCA; when IRA was RCA, a multi-vessel involvement included RCA and Cx; and when IRA was Cx, a single-vessel involvement included the left anterior descending (LAD) artery most frequently, and RCA+LAD less frequently (p=0.000). In inferior AMI, RCA was the most common IRA; however, the possibility of multi-vessel disease is increased when Cx is found to be the IRA. In patients presenting with inferior AMI, the presence of ST-depression in the leads aVL and V1-2 is a sensitive finding that indicates Cx stenosis rather than RCA stenosis and is not affected by coexisting other coronary artery involvements.     

急性下壁心肌梗死患者心电图预测梗塞部位的研究

目的 探讨心电图用于预测急性下壁心肌梗死患者梗塞部位的可行性.方法 利用标准12导心电图预测冠状动脉梗塞部位.如:右冠状动脉(RCA)右心室分支的近端梗塞,RCA右心室分支的远端梗塞,左回旋支(LCX)梗塞.选择152名首次发生下壁心肌梗死患者,症状发生后12h行冠状动脉血管造影.血管造影前全部患者采用标准12导心电图.结果V_3/Ⅲ比率分别是0.2±0.3,0.8±0.5,2.5±2.5,(P=0.0001).V_3/Ⅲ比率<0.5为RCA近端梗塞,V_3/Ⅲ比率>0.5或≤1.2为RCA远端梗塞V_3/Ⅲ比率>1.2为LCX梗塞,其敏感性分别为91%,93%,95%.结论 V_3/Ⅲ比率对预测急性下壁心肌梗死患者冠状动脉梗塞部位极有帮助.