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目的:分析急性冠状动脉左主干(LM)闭塞的常规心电图(ECG)表现,总结其ECG特点。方法:15例急性心肌梗死(AMI)患者经冠状动脉造影证实为急性LM闭塞(LM组),回顾性分析其急诊ECG表现。并选取同时期30例左前降支(LAD)近段闭塞的AMI患者(LAD组),比较2组造影前的急诊ECG表现,以求总结急性LM闭塞的常规ECG特点。结果:LM组心率快于LAD组,心律失常发生率2组差异无统计学意义。LM组中13例患者存在aVR导联ST段抬高(≥0.05mV),发生率明显高于LAD组(分别为86.7%和36.7%,P<0.01),同时LM组aVR导联ST段抬高幅度亦明显大于LAD组。而LM组胸前导联V1～3的ST段抬高程度则明显低于LAD组。aVR导联ST段抬高>0.05mV诊断急性LM闭塞的敏感性为90%,特异性为63.3%。如果同时再满足V1～3导联ST段抬高程度<0.5mV,其诊断急性LM闭塞的敏感性为90%,特异性达到86.7%。结论:aVR导联ST段抬高≥0.05mV,同时伴有V1～3导联ST段抬高不明显、甚至压低是急性LM闭塞区别于LAD闭塞的ECG特点,结合临床表现,分析ECG特点可能有助于造影前预测此类患者和进行风险评价。
OBJECTIVE: To analyze the conventional electrocardiogram (ECG) findings of acute left main coronary artery occlusion (LM) and summarize its ECG characteristics. Methods: Fifteen patients with acute myocardial infarction (AMI) underwent acute LM occlusion by coronary angiography (LM group), and their emergency ECG findings were retrospectively analyzed. Thirty patients with AMI (LAD group) with proximal occlusion of the left anterior descending artery (LAD) were enrolled in this study. The performance of emergency ECG before angiography was compared between two groups in order to summarize the conventional ECG characteristics of acute LM occlusion. Results: The heart rate of LM group was faster than that of LAD group. The incidence of arrhythmia was no significant difference between the two groups. In the LM group, 13 cases of aVR lead ST segment elevation (≥0.05mV), the incidence was significantly higher than the LAD group (86.7% and 36.7%, P <0.01), while the LM group aVR lead ST segment elevation High amplitude is also significantly greater than the LAD group. However, the elevation of ST segment in V1 ~ 3 of the lead of the LM group was significantly lower than that in the LAD group. AVR lead ST segment elevation> 0.05mV diagnosis of acute LM occlusion with a sensitivity of 90%, a specificity of 63.3%. If at the same time to meet the V1 ~ 3 lead ST segment elevation <0.5mV, the diagnosis of acute LM occlusion sensitivity was 90%, specificity of 86.7%. Conclusion: The ST segment elevation in aVR leads is greater than or equal to 0.05 mV, accompanied by an obvious ST segment elevation in V1 ~ 3 leads. The depression may be an ECG feature that distinguishes acute LAD occlusion from LAD occlusion. According to the clinical manifestations, ECG characteristics may be analyzed It helps to predict such patients before angiography and conduct risk assessment.