摘要
目的探讨心电图ST抬高Ⅲ>Ⅱ、Ⅲ≤Ⅱ、aVLⅠ型、aVLⅡ型及STⅢ/V3比值对判定急性下壁心肌梗死(AIMI)缺血-梗死相关动脉(IRA)价值及与冠脉分布关系。方法对65例急性冠脉综合征(ACS)患者心电图和冠状动脉造影资料进行对比分析。结果(1)AIMI中右冠状动脉(RCA)闭塞时ST抬高Ⅲ>Ⅱ发生率明显增高(P<0.01),其预测RCA近中段闭塞的Se、Sp、PPV、NPV、A均较高,分别达到96%、100%、100%、67%、97%;冠状动脉左旋支(LCX)闭塞时ST抬高Ⅲ≤Ⅱ发生率高(P<0.05),其预测LCX闭塞的Se、Sp、PPV、NPV、A分别达到100%、96%、67%、100%、97%。(2)LCX闭塞时aVL导联Ⅰ型发生率高(P<0.05),判定LCX型AIMI的Se、Sp、PPV、NPV、A分别为100%、86%、33%、100%及87%;RCA闭塞时aVL导联Ⅱ型的发生率增高(P<0.05),判定RCA型AIMI的Se、Sp、PPV、NPV、A分别为86%、100%、100%、33%及87%。(3)Ⅲ/V3<0.5、0.5≤Ⅲ/V3≤1、Ⅲ/V3>1对预测LCX型AIMI、LCX型AIMI及RCA型AIMI的Se、Sp、PPV、NPV、A分别为50%、89%、25%、96%及87%;50%、93%、33%、96%、90%;82%、100%、100%、29%、83%。(4)在ST段抬高的AIMI中仅ST抬高Ⅲ>Ⅱ、Ⅲ≤Ⅱ与冠状动脉分布类型有关。结论aVL导联QRS波群以及Ⅲ和Ⅱ导联ST段抬高幅度的特异性变化对判定急性下壁心肌梗死缺血-梗死相关血管有较好预测价值,并与冠脉分布有一定关系。
Objective To investigate the value of the electrocardiogram in predicting the infarct-related artery in inferior wall acute myocardial in/arction and the relation between electrocardiogram and coronary distribution. Methods The early electrocardiogram and coronary angiographic findings in 65 patients with acute coronary artery syndrome were analyzed. Results （1） from the right coronary artery（RCA） group in inferior wall acute myocardial infarction, the incidence rate of ST Ⅲ 〉 Ⅱ（ST-segment elevation in lead Ⅲ exceeding that of lead Ⅱ ） was obviously high（P〈0.01） and the sensitivities, specificities, positive-predictive values, negative-predictive values and accuracies were 96%, 100%, 100% ,67% and 97% respectively when STⅢ〉 Ⅱ was used to predict proximal and middle RCA; from the left circumflex artery（LCX） group in inferior wall acute myocardial infarction, the incidence rate of STⅢ≤Ⅱ （ST-segment elevation in lead Ⅱ exceeding or equal to that of lead Ⅲ） was high（P〈0.05） and the sensitivities, specificities, positive-predietive values, negative predictive values and accuracies were 100% ,96%, 67%, 100% and 97% respectively when STⅢ≤Ⅱ was used to predict LCX. （2）From the LCX group in inferior wall acute myocardial infarction, the incidence rate of aVL Ⅰ （the type Ⅰ of aVL） was high（P〈0.05） and the sensitivities, speeificities, positive-predictive values, nega tive-predictive values and accuracies were 100% ,86% ,33%, 100% and 87% respectively when aVL Ⅰ was used to predict LCX; From RCA group in inferior wall acute myocardial infarction, the incidence rate of aVL Ⅱ （the typeⅡ of aVL） was high（P〈0.05） and the sensitivities, speeificities, positive-predictive values, negative-predictive values and accuracies were 86%, 100%, 100%, 33% and 87% respectively when aVL Ⅱ was used to predict proximal and middle RCA. （3）The sensitivities, specificities, positive-predictive values, negative-predictive values and accuracies were 50%, 89%, 25%, 96% and 87% respectively when Ⅲ/V3 〈0. 5 was used to predict LCX; the sensitivities, specifieities, positive-predictive values, negative-predictive values and accuracies were 50% ,93% ,33% ,96% and 90% respectively when 0.54 Ⅲ/V3≤1 was used to predict LCX; the sensitivities, specificities, positive predictive values, negative-predictive values and accuracies were 82 %, 100 %, 100 %, 29 % and 83 % respectively when Ⅲ/V3 〉 was used to predict RCA. （4）Only ST Ⅲ〉Ⅱ and ST Ⅲ≤Ⅱ in ST-segment elevation myocardial infarction could relate to distribution of coronary artery. Conchlsion STⅢ〉Ⅱ ,STⅢ≤Ⅱ ,aVL Ⅰ and aVL Ⅱare effective electrocardiographic criteria in predicting the infarct-related artery in inferior wall acute myocardial infarction and maybe relate to the distribution of coronary.
出处
《重庆医学》
CAS
CSCD
2006年第1期28-31,共4页
Chongqing medicine
关键词
心电图改变
急性冠脉综合征
缺血-梗死相关动脉
心电描记术
冠状动脉造影
electrocardiographic change
acute coronary artery syndrome
ischemic-related artery
electrocardiography
coronary arteriongraphy
