Relationship between electrocardiographically estimated infarct size and clinical findings in inferior myocardial infarction

In 270 patients with acute inferior wall myocardial infarction (MI) and no previous MI, Q- and R-wave changes in leads II, III, and aVF in a 12-lead standard ECG were related to the clinical course during hospitalization and 3-month follow-up. Patients with ECG-defined transmural MI showed a higher incidence of tachycardia, high degree of AV block, congestive heart failure (CHF), and pericarditis than patients with nontransmural MI. In a subgroup including 226 patients, the series was divided into quartiles according to the sum of Q- and R-wave changes in leads II, III, and aVF 4 days after arrival in hospital. A weak correlation between ECG-determined infarct size and the incidence of complications such as congestive heart failure (CHF), need for furosemide, and pericarditis, as well as the duration of hospitalization was observed. It is concluded that ECG-determined infarct size from leads II, III, and aVF in inferior MI is associated with the clinical course, although it cannot predict the outcome in the individual patient.     

Relationship between electrocardiographically estimated infarct size and morbidity during a two-year follow-up

In 587 patients with a first myocardial infarction (MI) the electrocardiographically (ECG) estimated infarct size was related to morbidity during a two-year follow-up. Patients with transmural MI (Q- or R-wave changes in standard ECG) were more often treated for heart failure and returned to work less frequently than patients with subendocardial MI (ST-T-wave changes only). There were trends indicating a higher reinfarction rate in patients with subendocardial MI, whereas angina pectoris was observed as frequently in both groups. In a subset of patients with anterior MI, infarct size was estimated from the total Q- and R-wave amplitude in 24 precordial leads 4 days after arrival in hospital. A positive relationship was observed between ECG-estimated infarct size and treatment for heart failure, and patients with smaller infarctions according to ECG criteria returned to work less frequently. A higher reinfarction rate was observed in patients with smaller infarctions. In patients with inferior MI there were mostly weaker correlations between ECG-estimated infarct size (Q- and R-wave changes in leads II, III, and a VF) and morbidity during the two-year follow-up.     

The relationship between the electrocardiographically estimated infarct size and 1- and 2-year survival in acute myocardial infarction

In 587 patients with acute myocardial infarction (AMI) and no previous MI, electrocardiographically estimated infarct size was related to 1- and 2-year mortality. The overall mortality was higher in patients with transmural MI (Q- or R-wave changes in standard ECG) than in patients with subendocardial infarction (ST-T-wave changes in standard ECG) after 1 year (18.8% compared to 6.5% p less than 0.001) and after 2 years (22.2% compared to 13.8%, p = 0.049). When patients who were alive during primary hospitalization were analyzed separately, slightly higher mortality was found in patients with transmural MI than in subendocardial MI after 1 year (9.6% compared to 4.2%, p = 0.076) while no difference was found after 2 years (13.4% as compared to 11.7%, p greater than 0.2). In a subgroup of patients with anterior MI, precordial mapping with 24 chest leads was analyzed 4 days after arrival in hospital (n = 197). Patients were divided into quartiles according to the sum of R waves, the sum of Q waves, and the number of Q waves. There was a similar overall mortality in each quartile after 1 year and after 2 years regardless of ECG parameters studied. Neither did we find any correlation between the sum of R waves in leads II, III, and aVF on the fourth day in patients with inferior MI and overall 1- or 2-year mortality rate, although there was a trend towards higher mortality with more ECG changes.     

Relationship between electrocardiographically and enzymatically estimated size in anterior myocardial infarction

In 179 patients with anterior myocardial infarction the electrocardiographically estimated infarct size was related to serum enzyme activity. A precordial map containing 24 precordial positions and the peak activity of heat stable dehydrogenase (LD; EC 1.1.1.27) were used. A positive correlation was found between the area at risk (initial sum of ST-elevation) and the peak LD activity (r = 0.48 - 0.55; p less than 0.001). When the final Q-and R-wave amplitude were related to peak enzyme activity a better correlation was observed (r = 0.56 - 0.68; p less than 0.001). The sum of R-waves (sigma R) and the sum of Q-waves (sigma Q) in the 24 precordial leads were related to sigma R and sigma Q in five precordial standard leads. A good correlation was found between the two ECG methods (r = 0.75 - 0.83; p less than 0.001), indicating that an increased number of precordial leads gives information regarding the extent of infarction similar to that obtained with the routinely used standard leads. It is concluded that in the individual patient, serum enzyme activity and the final Q-and R-wave changes can give different information about infarct size. If, however, these two independent methods are used in a large number of patients in intervention studies they will probably give similar information about relative influence of the intervention on the mean infarct size.     

Reassessing the clinical significance of electrocardiographically unrecognized myocardial infarctions: Radionuclide infarct size and its impact on long-term prognosis

Background

Silent or unrecognized myocardial infarction (UMI) diagnosed by surveillance electrocardiography (ECG) carries similarly poor prognosis as recognized MI (RMI) for poorly understood reasons.

Methods

This study included 5430 consecutive patients who presented to the nuclear laboratory and underwent 2-day stress and rest Tc-^99m sestamibi and ECG studies between March 1991 and June 1999. UMI was diagnosed if ECG showed Q-wave MI in the absence of a history of RMI. We measured infarct size (% defect size as compared with the entire left ventricular sestamibi uptake), ejection fraction (EF, %), and summed difference score (SDS, sestamibi uptake by myocardium in stress minus sestamibi uptake in rest images as a marker of ischemia). Survival was determined by follow-up survey (median 6 years).

Results

We identified 346 UMIs, 628 RMIs, and 4456 subjects without MI (No MI). As compared with RMI, UMI patients had lesser abnormalities on nuclear scans (p < .0001 for all), including smaller infarct size (5.7% vs. 12.2%), higher EF (58% vs. 53%), and lesser ischemia (SDS; 3.9% vs. 2.7%). UMI prognosis was as poor as that of RMI (annual mortality rate 4.7% vs. 4.8% with No MI rate of 2.9%; p < .001 for all comparisons), and this persisted after multivariate analysis. Infarct size quantification successfully risk-stratified ECG-UMI patients, but UMI patients continued to predict mortality even if the infarct size was 0%.

Conclusions

Although UMI patients have lesser abnormalities on nuclear scans, ECG-based UMI continues to independently predict mortality, indicating the continuing relevance of ECG in clinical practice.     

Morbidity during five years after myocardial infarction and its relation to infarct size

In 809 patients with a recent myocardial infarction, morbidity during 5-year follow-up was assessed. The overall 5-year mortality rate was 33% (39% in patients with larger infarcts and 26% in patients with smaller infarcts) as judged from maximum serum enzyme activity (p less than .001). In terms of morbidity, no significant association with estimated infarct size was observed. Patients with smaller infarcts tended to have a higher reinfarction rate and were rehospitalized more often, whereas a similar proportion of patients with large and small infarcts developed stroke. Among survivors, chest pain tended to be more common in patients having smaller infarcts, whereas symptoms of dyspnea and claudicatio intermittens were similar in both groups, as were smoking habits, work capability, and varying forms of medication. We thus conclude that during a 5-year follow-up after acute myocardial infarction, mortality, but not morbidity, was related to the original infarct size.     

血清促红细胞生成素水平与急性心肌梗死患者梗死面积有关

目的观察血清促红细胞生成素（EPO）水平与急性心肌梗死（AMI）直接经皮冠状动脉介入（PCI）治疗后梗死面积的关系。方法初次急性ST段抬高型心肌梗死86例,在发病12 h内成功地接受了PCI的患者测定血清EPO和肌酸肌酶（CK）,并计算其CK累积释放量。以EPO中间值（19.6 U/L）分为高EPO组[（39±17）U/L]和低EPO组[（14±4）U/L],对两组CK累计释放量进行比较,并对CK累积释放量的可能影响因素做多元逐步回归分析。结果CK累积释放量在血清高EPO组明显低于低EPO组[（1 150±226）μkat/（L.h）vs（1 740±210）μkat/（L.h）,P<0.05)]。多元逐步回归分析显示,血清EPO水平、PCI术后TIMI血流等级和梗死前心绞痛是CK累积释放量的独立预测因子。结论内源性EPO水平高者AMI成功地直接PCI术后梗死面积较少,两者呈负相关。     

Effect of spontaneous reperfusion on myocardial infarct size

The effect of perfusion of the infarct artery on myocardial infarct size was studied in 39 patients who had not received interventive therapy. At predischarge coronary angiography, 19 patients had subtotal and 20 total occlusion of the infarct artery. The early ST-segment elevation recorded on a 12-lead electrocardiogram was used as an index of the amount of initially jeopardized myocardium. Infarct size was estimated by peak serum creatine kinase and, at discharge, by a QRS score, sigma Q and sigma R on a 12-lead electrocardiogram, and by radionuclide global and infarct segment left ventricular ejection fraction. Despite a similar degree of initial ischemia (sigma ST), infarct size was smaller in the 11 patients with anterior infarction and subtotal occlusion than in the 9 patients with anterior infarction and total occlusion when measured by peak serum creatine kinase (2114 +/- 1192 U/l vs. 3653 +/- 1059 U/l, p less than 0.02), QRS score (5.0 +/- 2.7 vs. 9.6 +/- 3.5, p less than 0.01), sigma Q (3.25 +/- 2.74 mV vs. 5.92 +/- 3.56 mV, p less than 0.10), sigma R (4.36 +/- 1.25 mV vs. 2.16 +/- 0.91 mV, p less than 0.001), global left ventricular ejection fraction (45.0 +/- 12.2% vs. 33.4 +/- 6.7%, p less than 0.05), and infarct segment ejection fraction (40.4 +/- 8.2% vs. 30.3 +/- 5.4%, p less than 0.05). In the inferior infarct patients, both the degree of initial ischemia and final infarct size were similar in the 8 patients with subtotal and in the 11 patients with total occlusion.(ABSTRACT TRUNCATED AT 250 WORDS)     

The effect of intravenous nitroglycerin on coronary blood flow and infarct size during myocardial infarction in conscious dogs

Nitroglycerin (TNG), based on electrocardiographic evidence, has been shown to reduce myocardial ischemia, but its effect on morphometrically and enzymatically estimated infarct size has not been defined. Accordingly, coronary occlusion was produced in 50 conscious dogs without LV failure. Twenty-five received TNG (200–300 m?g/min i.v. for 8 h) and the results compared with those in 25 untreated dogs. Coronary blood flow was measured with ¹⁴¹Ce, ⁸⁵Sr, and ⁹⁵Nb (9 m?m) after occlusion before TNG, 30 min after TNG, and again at 8 h. Mean blood pressure decreased from 103 to 84 mmHg with TNG vs. 99 to 94 mmHg in controls (p<0.02). Average heart rates were similar [135±26 vs. 120±33 beats/min (SD)]. TNG Did not increase total transmural coronary flow in any region but increased subendocardial flow in the central ischemic areas by 45% (0.09 ml/min/g vs. 0.13 ml/min/g). Animals were sacrificed after 24 h. Infarct size estimated morphometrically (25± 1.5 vs. 26± 1.5 of LV weight) and from myocardial CK depletion (23±2 vs. 23±2) was similar for the two groups. Thus, despite increased subendocardial flow, prolonged i.v. TNG did not decrease infarct size even though a difference of 15% would have been detected with this sample size. TNG May relieve coronary spasm but does not appear to be beneficial with sustained coronary occlusion.     

冠状动脉临界病变和急性心肌梗死的关系简

目的 通过分析急性心肌梗死前不同的冠状动脉（冠脉）造影基础病变特征和心肌梗死发病时间的关系,进一步探讨急性心肌梗死的发病机制和冠状动脉粥样硬化性心脏病（冠心病）的防治策略.方法 入选2005年6月到2011年11月因急性心肌梗死行介入治疗的患者104例.所有患者心肌梗死前都曾在阜外心血管病医院冠心病诊治中心行冠脉造影术或冠脉支架植入治疗.根据冠脉造影定量分析基础病变的狭窄程度,将患者分成3组（＜50％狭窄程度即轻度病变组,50％～70％狭窄程度即临界病变组,＞70％狭窄程度即严重狭窄组）.比较3组的基础病变特征,分析3组基础病变狭窄程度和心肌梗死发病时间的关系.结果 基础病变为临界病变的患者中有经皮冠状动脉介入治疗病史的较多,3组比较,差异有统计学意义[50％（13/26）vs.82.5％（47/57）vs.66.7％（14/21）,P=0.009].心肌梗死基础病变特征中,＞70％狭窄程度的患者狭窄程度重、病变长度较长、最小血管内径较小（P＜0.001）.12个月内与12个月后进展为心肌梗死的基础病变比较,狭窄程度较重（P=0.002）.基础病变狭窄程度与心肌梗死时间成负相关（r=-0.421,P＜0.001）,基础病变狭窄程度进展与心肌梗死时间成正相关（r=0.467,P＜0.001）.结论 冠脉轻度病变或临界病变,部分是随时间延长不断进展为更严重的狭窄后导致了急性心肌梗死.基础狭窄程度严重的病变（＞70％狭窄程度）,是短时间内发生急性心肌梗死的重要病因.     

心电图预测急性下壁心肌梗死相关冠脉的研究

目的探讨心电图对急性下壁心肌梗死相关冠脉的预测价值。方法根据冠状动脉造影证实的梗死相关冠脉结果,将153例急性下壁心肌梗死患者分为两组:右冠状动脉(RCA)闭塞组106例,回旋支(LCX)闭塞组47例。对两组患者心电图不同导联典型心肌梗死图形的发生率及ST-T改变发生率进行分析。结果RCA组STaVL↓>STl↓①、STIII↑>STII↑②、①+②、STaVF+V2>0的发生率均明显高于LCX组(x2=14.23,29.86,p<0.01),敏感性分别为75.8%、87.2%、70.9%、84.8%,特异性分别为83.9%、85.1%、100%、100%。LCX组①②两项均不具备、STaVF+V2<0的发生率明显高于RCA组(x2=42.43,49.26,p<0.01),敏感性分别为83.7%和94.0%,特异性均为100%。结论心电图STaVL↓>STl↓①、STIII↑>STII↑②、①+②、STaVF+Ⅴ2>0与①②两项均不具备、STaVF+V2<0对判断急性下壁心肌梗死的梗死相关动脉是RCA或LCX和闭塞位置有高度特异性,有重要的预测价值。     

Captopril in acute myocardial infarction: Beneficial effects on infarct size and arrhythmias

It is known from experiments that angiotensin-converting enzyme inhibitors can limit infarct size. In a prospective, randomized, placebo-controlled double-blind study, 22 patients were given 1.5–2.0 mg captopril/h I.V., while 24 patients were given placebo. Medication was started between 2 and 18 h from the onset of infarction. The two groups were matched for age, infarct location, and time of intervention. With the exception of one patient in either group, all were concurrently given nitroglycerin. The necrosis parameters were provided by the quantitative measurement of the QRS complex. The Q wave decreased with captopril treatment (—0.003 mV), but increased with placebo (+0.14 mV, p < 0.05). The number of ventricular premature beats at 24 h from the start of treatment was 25/h with placebo, and 9/h with captopril (p < 0.02). Ventricular fibrillation occurred seven times in the placebo group, but did not occur in the captopril group. The creatine kinase infarct weight was 59 gram-equivalents (gEq) with placebo, and 45 gEq with captopril (p = NS). Mean arterial pressure was reduced by 12 mmHg with captopril treatment. The results show a beneficial effect of captopril on infarct size and electrical instability, over and above the effect of standard management with nitroglycerin and thrombolysis.     

有氧运动联合抗阻运动对急性心肌梗死患者微循环及梗死面积的影响

目的：探讨急性心肌梗死（AMI）患者应用有氧运动联合抗阻运动对心肌微循环及梗死面积的影响,为临床上治疗AMI提供更广泛的治疗手段。方法选择2013年1月至2014年12月首发入住哈尔滨市第一医院的AMI患者86例,随机分为治疗组（n＝43）及对照组（n＝43）。两组患者均给予药物治疗,治疗组在药物治疗的基础上进行为期12周的有氧运动?抗阻运动治疗。于治疗前和治疗12周后对两组患者的峰值氧耗量（VO2max）、相对最大摄氧量（VO2max/kg）、峰值氧脉搏（VO2max/HR）、最大心率（HRmax）、最大通气量（VEmax）、心肌声学造影（MCE）结果进行评价和比较。结果治疗前,两组间VO2max、VO2max/kg、VO2max/HR、HRmax、VEmax各项指标比较,差异均无统计学意义（P＞0.05）。治疗12周后,两组的VO2max、VO2max/kg、VO2max/HR、HRmax、VEmax比较,差异均有统计学意义（P＜0.05）。治疗前,心肌声学造影显示两组间的A（平台期强度）、κ（再充盈平均速度）、及A·κ值无明显差异（P＞0.05）。12周后,治疗组的3项指标较对照组明显增加（P＜0.05）。结论在急性心肌梗死患者的心脏康复方案中采用有氧运动与抗阻训练相结合的训练方法,可以使患者心肌微循环及梗死面积得到不同程度的改善,该方法为临床上治疗AMI提供一种新的思路及更广泛的治疗手段。     

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。     

体表心电图对老年急性前壁心肌梗死左前降支闭塞部位的预测价值

目的探讨体表心电图对老年急性前壁心肌梗死左前降支（LAD）闭塞部位的预测价值。方法对62例老年急性前壁心肌梗死患者的入院心电图和冠状动脉造影资料进行回顾性分析,寻找可以预测LAD闭塞部位的心电图改变。结果62例老年急性前壁心肌梗死患者均为LAD闭塞,其中近段闭塞者45例（72.6%）,远段闭塞者17例（27.4%）。经χ2检验,STⅠ抬高、STaVL抬高、STaVF压低或至少2个下壁导联ST段压低等指标提示LAD近段闭塞（P均〈0.05）。其中,STaVF压低或至少2个下壁导联ST段压低的特异度和阳性预测值最高,为94%左右,灵敏度以STaVL抬高最高,为56%;反之,STaVL压低和STⅢ抬高则在预测LAD远段闭塞上有显著意义（P均〈0.05）,特异度和阳性预测值以STaVL压低为最高,均为100%。结论急性前壁心肌梗死时,体表心电图对预测LAD闭塞部位有重要价值。     

心电图诊断冠脉前降支闭塞部位的研究

目的 探讨前壁急性心肌梗死(AMI)体表心电图(ECG)预测前降支(LAD)阻塞部位的准确率.方法 对2010年6月至2013年12月在井冈山大学附属医院心血管科145例前壁AMI患者ECG预测阻塞部位与冠状动脉造影术(CAG)显示阻塞部位进行对比分析.以大对角支(LD)或第一对角支(D1)为界划分LAD为近远段.结果 前间壁AMI 20例,LAD阻塞部位均在LD或D1开口以远.前壁AMI、前壁+下壁AMI共67例LAD阻塞部位大多在LD或D1开口以远(80.6％ vs.86.6％),两种分界法差异无统计学意义(p=0.351).广泛前壁、广泛前壁+高侧壁、前壁+高侧壁AMI共58例LAD阻塞部位多发生LD或D1开口以近(96.55％vs.72.4％),两种分界法差异有显著的统计学意义(p=0.000),以LD为界有较高的阳性预测值(96.55％ vs.72.41％ p=0.000)、特异度(97.3％ vs.83％,p=0.003),心电图判断LAD近段阻塞以LD分界更准确.结论 前壁AMI心电图对预测LAD阻塞部位有较高的准确率.     

早发冠心病心肌梗死型与非心肌梗死型危险因素差异分析

目的探讨早发冠心病中心肌梗死型与非心肌梗死型的危险因素差异。方法回顾性分析2004年1月至2009年12月在沈阳医学院附属奉天医院心血管内科住院并确诊的45岁及以下冠心病患者165例,分为急性心肌梗死(AMI)组和非AMI组。对两组患者的相关临床资料及危险因素进行统计分析。结果 AMI组吸烟史比例、男性比率、血浆纤维蛋白原及D-二聚体均高于非AMI组,差异有统计学意义(P<0.05),两组的血脂异常率、血小板计数(PLT)、血小板压积、凝血酶原时间(PT)、国际标准化比值(INR)和活化部分凝血活酶时间(APTT)的差异无统计学意义。结论吸烟、男性性别、血脂水平异常是早发冠心病重要危险因素;血浆纤维蛋白原水平增高对于预测早发冠心病心肌梗死可能具有一定的临床意义。     

Effectiveness of intravenous streptokinase on infarct size and left ventricular function in acute myocardial infarction. Prospective and randomized study

Within 3 h after the onset of symptoms of myocardial infarction, 64 patients were randomly assigned to receive either a 1-h intravenous infusion of 1,500,000 IU of streptokinase (SK) or a conventional therapy. Infarct size was estimated in CK gram equivalent (CKg) by measurement of CK-MB every 3 hours during a 48-h period. Enzymatic study revealed that myocardial infarction of the SK group was significantly smaller (61.4 +/- 45 vs. 89.4 +/- 56 CKg, p less than .05). Angiograms were performed at early stage and five weeks after myocardial infarction. At first coronary angiogram, the infarct-related vessel was open in 82% in the SK group versus 12% in controls. The SK group had higher global ejection fraction at second angiogram (57 +/- 11% vs. 49 +/- 11%, p less than .02), but differences in regional wall motion were not significant. By analysis according to patency or occlusion of infarct-related vessel, global and regional ejection fractions were significantly better at first and at second angiograms in all patients and in anterior infarctions with a patent infarct-related coronary artery. There was no significant difference for inferior infarction. We conclude that intravenous streptokinase infusion early after the onset of myocardial infarction reduces infarct size and improves left ventricular function, chiefly in anterior infarction. This benefit appears to be closely correlated to patency of infarct-related vessels.     

Relationship between late potentials and the predischarge electrocardiographic pattern in patients with acute anterior wall myocardial infarction

Hypothesis: The presence of late potentials on the signalaveraged electrocardiogram (SAECG) identifies patients at high risk for development of ventricular tachyarrhythmias after myocardial infarction (MI). Methods: The electrocardiogram and left ventricular function in 65 patients recovering from a first acute anterior wall MI were analyzed. We compared the pattern of the ST segment (isoelectric or elevated) and of the T wave (positive or negative) with the SAECG using an orthogonal bipolar lead configuration (X, Y, Z) with bidirectional Butterworth filtering (Simson's method). Results: Abnormal SAECG was found in 17 (26%) patients; 11 of 18 patients with ST elevation had abnormal SAECG, and only 6 of 47 patients with isoelectric ST segment developed abnormal SAECG (p<0.0001, odds ratio = 10.74). Of 19 patients with positive T waves, 10 had abnormal SAECG, and abnormal SAECG was found in 7 of 46 patients with negative T waves (p<0.003, odds ratio = 5.27). When both parameters were considered together, 9 of 12 patients with ST elevation and positive T wave developed abnormal SAECG, and 35 of 40 patients with isoelectric ST and negative T wave had normal SAECG (p<0.0002). Left ventricular ejection fraction was similar in patients with abnormal SAECG (43 ± 14%) and normal SAECG (46 ± 11 %). Conclusion: These findings suggest that patients with anterior wall MI and a predischarge pattern of ST elevation and positive T wave have a higher incidence of abnormal SAECG and therefore may have a worse prognosis, especially related to the subsequent development of ventricular arrhythmias.     

急性前壁心肌梗死心电图ST段改变与前降支阻塞部位关系的研究

目的探讨急性前壁心肌梗死心电图的ST段改变与冠状动脉阻塞部位的关系。方法对34例急性前壁心肌梗死病人进行回顾性分析。结果34例患者中19例为前降支病变,15例为前降支合并多支血管病变,心电图STⅠ、aVL抬高,STⅡ、Ⅲ、aVF压低,STaVL>STⅠ,STV2>STaVR,STV3/Ⅱ<-2.3,均为前降支近端狭窄,STⅡ、Ⅲ、aVF、V5、V6抬高,STV5>STⅡ,STV6>STaVF,均为前降支远端狭窄。结论急性前壁心肌梗死病人进行心电图常规检查,可以预测梗死与冠状动脉阻塞部位的关系。STⅠ、aVL抬高,Ⅱ、Ⅲ、aVF压低>1mm,为前降支近端病变。Ⅱ、Ⅲ、aVF、V5、V6抬高>1mm为前降支远端病变。