急性前壁心肌梗死伴下壁导联ST段下移的临床意义

目的　探讨急性前壁心肌梗死患者入院时心电图下壁导联 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 1998年 1月～ 2 0 0 2年 10月住院诊治并行冠状动脉造影的急性前壁心肌梗死患者 5 9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 , 组 36例病变部位位于第一对角支发出前 , 组 2 3例病变位于第一对角支发出后。结果　 组 36例占 6 1.0 1% , 组 2 3例占 38.98%。 组病人多数合并下壁导联 ST段下移≥ 1mm ,在 、 、a VF导联分别为 81% ,92 % ,79%。 组多数 ST段位于等电位线或 ST段下移 <1m m,在 、 、a VF导联分别为 6 0 % ,6 1% ,5 3%。结论　急性前壁心肌梗死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 anterior myocardial infarction

Objective To study assess the significance of inferior ST-segment depression during anterior acute mycardial infarction(AMI) 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 AMI were enrolled from January 1998 to October 2002 in our hospital. All patients underwent angiography and ECG. Patients were allocated to two groups according to the relationship 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, In 23 patients(group two),the lesion located after origin of the first diagonal branch. Results Most of patients were ST-segment depression of ≥1mm in leads Ⅱ,Ⅲ, aVF(81%,92%,79% respectively)in group one( 61.01%), deviation or depression <1mm in leads Ⅱ,Ⅲ, aVF(60%,61%,53% respectively) in group two(38.98%).Conclusion It is possible to predict the lesion of LAD located before origin of the first diagonal branch by the admissioin electrocardioigram 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.