Yoshino H, Yotsukura M, Yano K, Taniuchi M, Kachi E, Shimizu H, Udagawa H, Kajiwara T, Ishikawa K
Second Department of Internal Medicine, Kyorin University School of Medicine, Mitaka, Tokyo, Japan.
J Electrocardiol. 2000 Jan;33(1):49-54. doi: 10.1016/s0022-0736(00)80100-4.
This study determines the usefulness of electrocardiography in the emergency room for assessing the risk of cardiac rupture after acute anterior myocardial infarction (MI). The presence of ST segment elevation on the admission 12-lead electrocardiography was evaluated in 325 consecutive anterior MI patients. A forward-stepwise logistic regression analysis for cardiac rupture was performed with the covariates of age, gender, hypertension, history of MI, reperfusion therapy by coronary angioplasty, and ST segment elevations in leads I, aVL, V1-V6. Cardiac rupture occurred in 16 patients, including 7 with left ventricular free wall rupture (FWR) and 9 with ventricular septal perforation (VSP). For FWR, ST elevation in lead aVL was the only independent predictor (odds ratio = 12.1, P = .0215). For VSP, female gender (odds ratio = 5.32, P = .0201) was the independent predictor. In conclusion, in patients with acute anterior MI, ST segment elevation in lead aVL on the admission electrocardiography is a significant risk factor for left ventricular FWR.
本研究确定了急诊室心电图在评估急性前壁心肌梗死（MI）后心脏破裂风险方面的作用。对325例连续性前壁MI患者入院时12导联心电图上ST段抬高情况进行了评估。以年龄、性别、高血压、MI病史、冠状动脉成形术再灌注治疗以及I、aVL、V1-V6导联ST段抬高为协变量，对心脏破裂进行向前逐步逻辑回归分析。16例患者发生心脏破裂，其中7例为左心室游离壁破裂（FWR），9例为室间隔穿孔（VSP）。对于FWR，aVL导联ST段抬高是唯一的独立预测因素（比值比=12.1，P=0.0215）。对于VSP，女性（比值比=5.32，P=0.0201）是独立预测因素。总之，在急性前壁MI患者中，入院心电图aVL导联ST段抬高是左心室FWR的重要危险因素。
