Engelen D J, Gorgels A P, Cheriex E C, De Muinck E D, Ophuis A J, Dassen W R, Vainer J, van Ommen V G, Wellens H J
Department of Cardiology, University Hospital Maastricht, Cardiovascular Research Institute, The Netherlands.
J Am Coll Cardiol. 1999 Aug;34(2):389-95. doi: 10.1016/s0735-1097(99)00197-7.
The study assessed the value of the electrocardiogram (ECG) as predictor of the left anterior descending coronary artery (LAD) occlusion site in relation to the first septal perforator (S1) and/or the first diagonal branch (D1) in patients with acute anterior myocardial infarction (AMI).
In anterior AMI, determination of the exact site of LAD occlusion is important because the more proximal the occlusion the less favorable the prognosis.
One hundred patients with a first anterior AMI were included. The ECG showing the most pronounced ST-segment deviation before initiation of reperfusion therapy was evaluated and correlated with the exact LAD occlusion site as determined by coronary angiography.
ST-elevation in lead aVR (ST elevation(aVR)), complete right bundle branch block, ST-depression in lead V5 (ST depression(V5)) and ST elevation(V1) > 2.5 mm strongly predicted LAD occlusion proximal to S1, whereas abnormal Q-waves in V4-6 were associated with occlusion distal to S1 (p = 0.000, p = 0.004, p = 0.009, p = 0.011 and p = 0.031 to 0.005, respectively). Abnormal Q-wave in lead aVL was associated with occlusion proximal to D1, whereas ST depression(aVL) was suggestive of occlusion distal to D1 (p = 0.002 and p = 0.022, respectively). For both the S1 and D1, inferior ST depression > or = 1.0 mm strongly predicted proximal LAD occlusion, whereas absence of inferior ST depression predicted distal occlusion (p < or = 0.002 and p < or = 0.020, respectively).
In anterior AMI, the ECG is useful to predict the LAD occlusion site in relation to its major side branches.
本研究评估了心电图（ECG）作为急性前壁心肌梗死（AMI）患者左前降支冠状动脉（LAD）闭塞部位相对于第一间隔支穿支（S1）和/或第一对角支（D1）的预测价值。
在前壁AMI中，确定LAD闭塞的确切部位很重要，因为闭塞越靠近近端，预后越差。
纳入100例首次发生前壁AMI的患者。评估再灌注治疗开始前显示最明显ST段偏移的ECG，并将其与冠状动脉造影确定的LAD确切闭塞部位进行关联分析。
aVR导联ST段抬高（ST elevation(aVR)）、完全性右束支传导阻滞、V5导联ST段压低（ST depression(V5)）以及ST elevation(V1)＞2.5mm强烈提示LAD在S1近端闭塞，而V4 - 6导联出现异常Q波与S1远端闭塞相关（p分别为0.000、0.004、0.009、0.011和0.031至0.005）。aVL导联异常Q波与D1近端闭塞相关，而ST depression(aVL)提示D1远端闭塞（p分别为0.002和0.022）。对于S1和D1，下壁ST段压低≥1.0mm强烈提示LAD近端闭塞，而下壁无ST段压低则提示远端闭塞（p分别≤0.002和≤0.020）。
在前壁AMI中，ECG有助于预测LAD相对于其主要分支的闭塞部位。
