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。

The value of 12-lead electrocardiogram on predicting infarct related artery in acute myocardial infarction

Objective To study the value of electrocardiogram(ECG)on predicting infarct related artery(IRA)in acute myocardial infarction(AMI).Methods We retrospectively analyzed electrocardiogram and coronary angiography of 132 AMI patients.Results In ECG,AMI mostly happened in inferior(23.5%),anteroseptal(19.7%),and extensive anterior(16.7%).IRA could be in all main coronary artery,2.3% was left main coronary artery(LM),55.3% was left anterior descending(LAD),13.6% was left circumflex(LCX),and 28.8% was right coronary artery(RCA).The IRA were mainly on LAD(92.7%)in anterior AMI,and were mainly on RCA(71.0%)or ICX(22.6%)in inferior AMI,ST segment elevation in lead aVL or aVR was a very specific sign of proxymal LAD occlusion in anterior infarction,and had a relatively high sensitivity for this diagnosis.Conclusion ECG is of great value on predicting the infarct related artery in patients with AMI.