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目的通过与冠状动脉造影(CAG)对比,研究aVR导联ST段改变的特征,对急性前壁心肌梗死(AAMI)的梗死相关动脉(IRA)阻塞部位的定位。方法对比89例急性前壁心肌梗死病人,其中左前降支近段(PS)闭塞43例、左前降支远段(DS)闭塞46例,胸痛发作12h内的心电图。结果两组胸导联的ST段抬高无明显差异,PS组aVR导联ST段抬高较明显(0.94±0.48mm vs0.30±0.56mm,p=0.021);PS组II、III、aVF导联ST段压低较显著(分别为-1.21±0.72mm vs-0.64±0.53mm,p=0.010;-1.63±0.92mm VS-0.98±0.39mm,p=0.016;-1.40±0.66mm vs-0.85±0.32mm,p=0.000)。在胸导联ST段抬高的同时,aVR导联ST段抬高预测左前降支(LAD)近段闭塞的敏感性(Se)、特异性(Sp)、符合率(CR)、阳性预测值(PPV)、阴性预测值(NPV)分别为60.47%、93.48%、77.53%、89.66%、71.67%。结论在胸导联ST段抬高的同时合并aVR导联ST段抬高和/或下壁导联的ST段压低,可预测左前降支近段闭塞。
Objective To investigate the characteristics of ST segment changes in lead aVR and the location of the occlusion site of infarct-related artery (IRA) in acute anterior myocardial infarction (AAMI) by comparing with coronary angiography (CAG). Methods A total of 89 patients with acute anterior myocardial infarction were enrolled in this study. Among them, 43 cases were occluded in the proximal left anterior descending artery (PS), 46 cases were occluded in the distal left anterior descending branch (DS) and 12 hours after the onset of chest pain. Results There was no significant difference in the ST segment elevation between the two groups. The ST segment elevation in aVR lead group was more significant in PS group (0.94 ± 0.48mm vs0.30 ± 0.56mm, p = 0.021); PS group II, III, aVF Lead ST segment depression was more significant (-1.21 ± 0.72mm vs-0.64 ± 0.53mm, p = 0.010; -1.63 ± 0.92mm VS-0.98 ± 0.39mm, p = 0.016; -1.40 ± 0.66mm vs-0.85 ± 0.32 mm, p = 0.000). At the same time of ST-segment elevation in the lead of chest, ST segment elevation in aVR lead was used to predict the sensitivity, specificity, coincidence rate (CR) and positive predictive value of proximal occlusion of left anterior descending artery (LAD) (PPV) and negative predictive value (NPV) were 60.47%, 93.48%, 77.53%, 89.66% and 71.67% respectively. Conclusions The ST segment elevation in aVR lead and / or the ST segment depression in inferior leads may be combined with ST segment elevation in the lead of the chest to predict proximal occlusion of the left anterior descending branch.