aVR 导联对急性心肌梗死中左主干病变的诊断意义

目的：通过分析急性心肌梗死患者12导联心电图，探讨心电图对左主干病变的诊断意义。方法对急性心肌梗死并行冠脉造影术的4914例患者进行分层随机抽样，根据造影结果，将样本分为左主干病变组及非左主干病变组。记录两组一般临床资料，盲法测量两组心电图，对比两组得出预测左主干病变的指标。结果二元 logistic 回归分析表明，aVR 导联 ST 段抬高≥0．05 mV（OR：8．160，P ＜0．05）是左主干病变的独立预测因子。联合 aVR 导联ST 段抬高≥0．05 mV、V4～V6导联 ST 段压低、≥5个导联 ST 段压低、aVF 导联低电压、QRS 波群时限＞100 ms 这5个无创性指标，可将确诊左主干病变的概率从25．19％提高到69．24％。5个心电图指标的阳性预测值分别为52．63％、32．73％、26．39％、16．22％和22．22％。结论心电图对急性心肌梗死中左主干病变的预测是可行的。aVR 导联 ST 段抬高≥0．05 mV 是预测左主干病变良好的心电图指标，联合多指标可提高心电图对左主干病变的诊断价值。

Diagnostic significance of lead aVR for left main coronary artery disease among acute myo-cardial infarction patients

Objective To explore the diagnostic value of electrocardiogram(ECG)for left main coronary artery disease (LMCA-D)by analyzing the 1 2 lead ECG of acute myocardial infarction (AMI)patients.Methods A total of 4 91 4 patients were enrolled in our study who had been diag-nosed with AMI and undergone coronary arteriography(CAG).In stratified random sampling method and based on CAG results,the sample was divided into LMCA-D group and non-LMCA-D group. We recorded the general clinical data of the two groups and their ECGs in blind measurement.By comparison of ECGs between the two groups,we obtained LMCA-D predictors.Results Binary lo-gistic regression analysis indicated that ST-segment elevation in lead aVR≥0.05 mV(OR:8.1 60, P <0.05)was an independent predictor of LMCA-D.With a combination of the five noninvasive in-dices including ST-segment elevation in lead aVR≥0.05 mV,ST-segment depression in lead V4 ~V6 ,the quantity of leads with ST-segment depression≥5,low voltage in lead aVF,and QRS com-plex duration >1 00 ms,the diagnostic probability of LMCA-D increased from 25.1 9% to 69.24%. The five indicators identified LMCA-D with positive predictive values of 52.63%,32.73%, 26.39%,1 6.22% and 22.22%,respectively.Conclusion ECG is feasible for predicting LMCA-D in AMI patients and ST-segment elevation in lead aVR≥0.05 mV is quite a favorable ECG indi-cator.Combination of various indicators helps to improve the diagnostic value of ECG for LMCA-D.