急性下壁心肌梗死时心电图ST段变化与罪犯血管分析

目的 探讨冠状动脉单支病变所致的急性下壁心肌梗死患者,罪犯血管为左回旋支动脉(LCX)或右冠状动脉(RCA)时心电图ST段的偏移特点.方法 1996年1月至2009年3月北京协和医院住院患者,ST段抬高型心肌梗死,梗死相关血管为单支LCX或RCA.定量分析心电图ST段的偏移特点.结果 LCX或RCA单支病变引起ST段抬高型心梗且资料完整者75例,LCX组及RCA组分别为16例、59例.右冠状动脉以第一转折处的前后分为RCA近段组、RCA远段组,分别为21例、38例.心电图I导联ST段压低、V1导联ST段抬高和I与aVL导联ST段均压低作为判断RCA为罪犯血管的敏感度分别为55.9%、74.6%、54.2%,特异度为81.3%、62.5%、81.3%,(P<0.05).aVR导联ST段压低≥0.1 mV、I导联ST段抬高和V5且V6导联ST段均抬高作为判断LCX为罪犯血管的敏感度分别为68.8%、81.3%、31.3%,特异度是76.3%、59.3%、91.5%,(P<0.05).V1导联的ST段不压低同时V2导联的ST段压低、胸前导联压低最大值出现在V1～V3导联在亚组中作为判断RCA近段病变的敏感度分别是47.6%、52.4%,特异度是78.9%、84.2%,(P<0.05).结论 在LCX或者RCA单支血管引起的ST段抬高心肌梗死心电图分析中,需要结合多个导联的ST段变化来判断罪犯血管.

Abstract：

Objective To explore the characteristics of ST-segment deviation in patients with acute ST elevation myocardial infarction (STEMI) having only one vessel lesion in either left circumflex artery (LCX) or right coronary artery (RCA).Methods All AMI (acute myocardial infarction) patients were admitted into Peking Union Medical College Hospital from January 1996 to March 2009. They underwent coronary angiography (CAG). And the IRA (infarction-related artery) was either LCX or RCA without other coronary artery stenosis. Their ST-segments deviations on electrocardiogram (ECG ) were analyzed quantitatively. Results Among 2503 AMT cases undergoing CAG during hospitalization, 75 cases had LCX ( n = 16) or RCA( n =59)-related STEMI. The RCA group was further divided into the proximal subgroup (n =21) and the distal subgroup (n =38). RCA as IRA was diagnosed when ST I depression <0, ST V1 elevation ≥0 or ST I and aVL depression <0 with the sensitivities of 55. 9% , 74. 6% and 54. 2% and the specificities of 81.3%, 62.5% and 81.3% respectively. LCX as IRA was diagnosed when ST aVR depression ≥0.1 mv, ST I elevation ≥0 or ST V5 and V6 elevation ≥0 with (he sensitivities of 68. 8% , 81. 3% and 31. 3% and the specificities of 76. 3% , 59. 3% and 91. 5% respectively. Proximal occlusion of RCA was diagnosed when there was no ST depression in V1 and depression in V2, Max precordial ST depression in V1 - V3 with the sensitivities of 47. 6% and52. 4% and the specificities of 78. 9% and 84. 2% . Conclusion While discriminating IRA in STEMI patients with single LCX or RCA lesion, it is necessary to assess all ST-segments deviations on ECG.

Deviation of ST-segment and detection of infarction related artery in patients with acute inferior wall infarction

Objective To explore the characteristics of ST-segment deviation in patients with acute ST elevation myocardial infarction (STEMI) having only one vessel lesion in either left circumflex artery (LCX) or right coronary artery (RCA).Methods All AMI (acute myocardial infarction) patients were admitted into Peking Union Medical College Hospital from January 1996 to March 2009. They underwent coronary angiography (CAG). And the IRA (infarction-related artery) was either LCX or RCA without other coronary artery stenosis. Their ST-segments deviations on electrocardiogram (ECG ) were analyzed quantitatively. Results Among 2503 AMT cases undergoing CAG during hospitalization, 75 cases had LCX ( n = 16) or RCA( n =59)-related STEMI. The RCA group was further divided into the proximal subgroup (n =21) and the distal subgroup (n =38). RCA as IRA was diagnosed when ST I depression <0, ST V1 elevation ≥0 or ST I and aVL depression <0 with the sensitivities of 55. 9% , 74. 6% and 54. 2% and the specificities of 81.3%, 62.5% and 81.3% respectively. LCX as IRA was diagnosed when ST aVR depression ≥0.1 mv, ST I elevation ≥0 or ST V5 and V6 elevation ≥0 with (he sensitivities of 68. 8% , 81. 3% and 31. 3% and the specificities of 76. 3% , 59. 3% and 91. 5% respectively. Proximal occlusion of RCA was diagnosed when there was no ST depression in V1 and depression in V2, Max precordial ST depression in V1 - V3 with the sensitivities of 47. 6% and52. 4% and the specificities of 78. 9% and 84. 2% . Conclusion While discriminating IRA in STEMI patients with single LCX or RCA lesion, it is necessary to assess all ST-segments deviations on ECG.