梗塞相关动脉病变位置与入院心电图

评价急性前壁心肌梗塞 (AAMI)病人入院心电图 (ECG)不同导联ST段变化预测前降支动脉(LAD)病变位置的价值。 10 7例AAMI病人 ,评价入院ECG每个导联ST段 ,并在 30天内完成冠状动脉造影检查 (CAG) ,明确引起AAMI病变与主要间隔支 ,第一对角支开口位置关系。IavL导联ST段抬高发生率在第一对角支近端 (Dp) ,远端 (Dd)病变间存在显著性差异 (I 89%Vs 18% ,avL 83%Vs 2 4 %P <0 0 0 2 5～0 0 0 1) ,其发生率主要间隔支近端病变 (Sp)也高于主要间隔支远端病变 (Sd)。Ⅱ ,Ⅲ、avF导联ST段压低发生率Sp病变明显高于Sd病变 (分别为 6 4 %Vs 9% ,90 %Vs 5% ,6 9%Vs 5% ,P <0 0 0 5～ 0 0 0 1) ,I导联ST段上移主要受Dp病变影响 ,而Ⅲ导联ST段下移最具有Sp病变诊断价值。AAMI病人入院ECG额面电轴导联ST段变化有助于明确LAD病变位置

Locating the Culprit Lesion of Infarct-Related Artery by Admission Electrocardiogram

To assess the value of ST segment changes in various leads of admssion electrocardogram(ECG)in predicting the site of culprit lesion in left anterior descending artery(LAD) during acute anterior wall myocardial infarcton (AAMI),Admission ECG was evaluated for ST segment amplitudes in 107 patents wth AAMI.Coronary angiogram(CAG)were performed in all patients with in 30 days of hospitalizaton,by which the culprit lesion resulted in AAMI were localized to the orign of sepital or/and dignoral branches.There were significant difference in prevalence of ST segment elevaton in leads I and avL between of the origin of dignoral branch and the group of patients with lesion distal of that.The difference also exsted in presepital lesion and distal sepital lesion.The depression of ST depression in leads Ⅱ、Ⅲ、avF were higher in patients with presspital lesion than that with distal sepital lesion(64% Vs 9%,90% Vs 5% and 69% Vs 5% for Ⅱ、Ⅲ and avF respectively,p\|value<0.005～0.001.)The presence of ST segment elevaton in lead I indicate the culprit lesion proximal of the origin of dignoral branch,and ST segment depression in lead Ⅲ was suggestive of a presepital lesion in LAD during AAMI.The changes of ST segment derivation in leads of frontal axis of admission ECG in patents wth AAMI are helpful in localizing the culprit lesion of left anterior artery.