心电图对急性前壁心肌梗死罪犯血管病变部位的预测价值

目的探讨急性前壁心肌梗死时体表心电图改变与冠状动脉病变部位的关系。方法回顾性分析80例急性前壁心肌梗死患者心电图改变与冠状动脉造影结果。结果80例患者中,前降支(LAD)近端病变(PD)组40例,远端病变(DD)组40例,两组间结果比较:(1)III、II、aVF导联ST段压低在PD组为45.0%,DD组为22.5%(P<0.05),预测LAD近端病变的灵敏度为45.0%,特异度为77.5%;III、II、aVF导联ST段抬高在PD组为2.5%,DD组为15.0%(P<0.05),预测LAD远端病变的灵敏度为15.0%,特异度为97.5%。(2)I、aVL导联ST段抬高在PD组为40.0%,DD组为15.0%(P<0.05),预测LAD近端病变的灵敏度为40.0%,特异度为85.0%(。3)STI/aVL<1在PD组为32.5%,DD组为5.0%(P<0.01),预测LAD近端病变的灵敏度和特异度分别为32.5%和95.0%。(4)ST V2/V3>1在PD组为60.0%,DD组为27.5%(P<0.01),预测LAD近端病变的灵敏度为60.0%,特异度为72.5%。结论III、II、aVF导联ST段压低与罪犯血管外合并其他血管病变无关,为LAD近端病变的有意义的判断指标;I、aVL导联ST段抬高,III、II、aVF导联ST段压低,STI/aVL<1以及STV2/V3>1有利于诊断LAD近端病变,而III、II、aVF导联ST段抬高为LAD远端病变的特异度指标。

The value of electrocardiogram for predicting the lesion site of acute anterior myocardial infarction

Objective To study the relationship between change in ECG and lesion site of acute anterior myocardial infarction(AAMI).Method The significance of ECG ST-segment changes in AAMI was studied in 80 patients who had coronary angiography.Results Eighty patients were allocated into two groups: 40 patients were obstructive in proximal lesion of left anterior descending coronary artery(LAD) as PD group,and another 40 in distal as DD group.Comparing the two groups:(1) There were 45.0% patients presenting ST-segment depression in leads II,III,aVF in PD group compared with 22.5% in DD group(P<0.05),ST-segment depression in leads II,III,aVF had sensitivity of 45.0% and specificity of 77.5% for proximal lesion.There were 2.5% patients presenting ST-segment elevation in leads II,III,aVF in PD group compared with 15.0% in DD group(P<0.05),ST-segment elevation in leads II,III,aVF had sensitivity of 15.0% and specificity 97.5% for distal lesion.(2) There were 40.0% patients presenting ST-segment elevation in leads I,aVL in PD group compared with 15.0% in DD group(P<0.05),ST-segment elevation in leads I,aVL had sensitivity of 40.0% and specificity 85.0% for proximal lesion.(3)There were 32.5% patients presenting STI/aVL<1 in PD group compared with 5.0% in DD group(P<0.01),STI/aVL<1 had sensitivity of 32.5% and specificity 95.0% for proximal lesion.(4)There were 60.0% patients presenting ST V2/V3>1 in PD group compared with 27.5% in DD group(P<0.01),ST V2/V3>1 had sensitivity of 60.0% and specificity of 72.5% for proximal lesion.Conclusions AAMI with ST-segment depression in leads II,III,aVF may suggest proximal lesion of LAD without accompanying with multiple coronary artery disease.ST-segment depression in leads II,III,aVF and ST-segment elevation in leads I,aVL and ST I/aVL<1,ST V2/V3>1 were sensitive or specific markers for proximal lesion of LAD.Whereas ST-segment elevation in leads II,III,aVF are specific markers for distal lesion of LAD.