心电图下壁导联ST段下移与左冠状动脉前降支“罪犯”血管的关系

目的:探讨急性冠脉综合征患者心电图下壁导联ST段下移与临床预后及左冠状动脉前降支“罪犯”血管病变部位之间的关系。方法:选择2000年1月~2005年1月住院诊治并行冠状动脉造影的急性冠脉综合征患者59例,依据冠状动脉造影所示左前降支“罪犯”血管病变部位与第一对角支起始部的关系分成两组,I组36例病变部位位于第一对角支发出前,Ⅱ组23例,病变位于第一对角支发出后。结果:I组36例占61.01%,Ⅱ组23例占38.98%。I组病人多数合并下壁导联ST段下移≥1mm,在Ⅱ、Ⅲ、aVF导联分别为81%,92%,79%。Ⅱ组多数ST段位于等电位线或ST段下移<1mm,在Ⅱ、Ⅲa、VF导联分别为60%,61%,53%。结论:急性冠脉综合征患者入院时心电图下壁导联ST段下移可以预测“罪犯”血管病变部位位于第一对角支起始部近端,而ST段位于等电位线或ST段下移<1mm预示病变部位位于前降支远端。

The Significance of the Inferior ST-segment Depression during Acute Coronary Syndrome

Objective: To assess the significance of inferior ST-segment depression during acute coronary syndrome(ACS) by investigating the relationship between inferior ST-segment depression and the site of left anterior descending(LAD) coronary artery"culprit"lesion.Methods: Fifty-nine patients with anterior ACS were enrolled from January 2000 to January 2005 in our hospital.All patients underwent angiography and ECG.Patients were allocated to two groups according to the felationship of site of the culprit lesion in the LAD artery and the origin of the first diagonal branch:In 36 patients(group one),the lesion located before origin of the first diagonal branch,and in 23 patients(group two),the lesion located after origin of the first diagonal branch.Results: Most of patients were ST-segment depression ≥1mm in leads Ⅱ,Ⅲ,aVF(81%,92%,79%,respectively) in group I(61.01%),deviation or depression <1mm in leadsⅡ,Ⅲ,aVF(60%,61%,53%,respectively) in group II(38.98%).Conclusion: It is possible to predict the lesion of LAD located before origin of the first diagonal branch by the admissioin electrocardiogram of patients with ST-depression in the inferior leads,whereas isoelectic ST or ST depression<1mm in leads Ⅱ,III,aVF suggests distal LAD artery occlussion.