QRS波宽度及aVR导联ST段抬高对NSTE-ACS左主干或三支病变的预测作用

目的研究非ST段抬高型急性冠脉综合征(NSTE-ACS)患者心电图的QRS波宽度及aVR导联抬高幅度对冠状动脉左主干/三支病变的诊断价值。方法分析106例NSTE-ACS患者的体表心电图QRS波宽度及aVR导联ST段抬高幅度,通过与冠状动脉造影结果对比,研究其对诊断左主干/三支病变的敏感性、特异性和相关性。结果 QRS波宽度及aVR导联ST段抬高是左主干/三支病变的独立预测因子,OR值分别为9.04(95%CI,4.88～16.7)、7.10(95%CI,4.91～76.2);QRS间期≥90ms和aVR导联ST段抬高≥0.5mm预测左主干/三支病变的敏感性及特异性分别为88%、76%及88%、86%。结论 QRS波增宽及aVR导联ST段抬高是NSTE-ACS患者左主干/三支病变较为灵敏的预测因子。

Actions of QRS duration and ST segment elevation of Lead aVR in prediction of left main coronary disease or three-vessel coronary disease of NSTE-ACS

Objective To study the diagnostic values of QRS duration and ST segment elevation of Lead aVR of ECG in the patients with left main coronary disease or three-vessel coronary disease of non-ST elevation acute coronary syndrome （NSTE-ACS）. Methods The width of QRS duration and rang ST segment elevation of Lead aVR elevation were analysed in 106 patients with NSTE-ACS. The sensitivity,specificity and dependability were studied in the diagnosis of left main coronary disease or three-vessel coronary disease with QRS duration and lead aVR elevation through the comparison of the outcomes of coronary angiography. Results The width of QRS duration and rang of lead aVR ST segment elevation were independent predictors, and their OR values were 9.04 （95% Cl,4.88 - 16.7 ） and 7.10 （95% Cl,4.91 -76.2） respectively. The sensitivity and specificity for predicting left main coronary disease or three-vessel coronary disease were 88% and 76% ,and 88% and 86% respectively when QRS interval was greater than or equal to 90 ms,and lead aVR ST segment elevation was greater than or equal to 0.5 mm. Conclusion The broaden of QRS duration and elevation of lead aVR ST segment are the sensitive predictors in the diagnosis of left main coronary disease or three-vessel coronary disease in the patients with NSTE-ACS.