Kosuge Masami, Kimura Kazuo, Ishikawa Toshiyuki, Endo Tsutomu, Sugano Teruyasu, Nakagawa Takeshi, Hibi Kiyoshi, Nakatogawa Tomoyori, Okuda Jyunn, Toda Noritaka, Tsukahara Kengo, Takamura Takeshi, Tahara Yoshio, Umemura Satoshi
Division of Cardiology, Yokohama City University Medical Center, Yokohama, Japan.
Clin Cardiol. 2004 Feb;27(2):106-11. doi: 10.1002/clc.4960270216.
Although anterior acute myocardial infarction (AMI) with ST-segment elevation in lateral leads is associated with a poor prognosis, the significance of the pattern of lateral ST-segment elevation has not been examined.
The aim of the study was to examine the relation of the pattern of lateral ST-segment elevation to myocardial reperfusion and infarct size in patients with AMI.
We studied 111 patients who had a first AMI presenting with anterolateral ST-segment elevation and Thrombolysis in Myocardial Infarction (TIMI) grade 3 flow of the left anterior descending coronary artery within 6 h from symptom onset. Patients were classified into two groups according to the pattern of lateral ST-segment elevation on the admission electrocardiogram: Group 1, 42 patients with equivalent or greater ST-segment elevation in lead I than in lead aVL, and Group 2, 69 patients with lesser ST-segment elevation in lead I in than in lead aVL. Left ventricular ejection fraction (LVEF) was measured by predischarge left ventriculography.
There were no differences between the two groups in age, gender, time from onset to recanalization, culprit lesion, or collateral development. Group 1 patients had a higher probability of impaired myocardial reperfusion as indicated by a myocardial blush grade of 0 or 1 after recanalization, a higher peak creatine kinase level, and a lower LVEF than Group 2 patients (p = 0.0001, respectively).
We conclude that equivalent or greater ST-segment elevation in lead I than in lead aVL is associated with impaired myocardial reperfusion and less myocardial salvage in patients with recanalized AMI who present with anterolateral ST-segment elevation on the admission electrocardiogram.
尽管前侧壁导联ST段抬高的急性前壁心肌梗死（AMI）预后较差，但侧壁ST段抬高模式的意义尚未得到研究。
本研究的目的是探讨AMI患者侧壁ST段抬高模式与心肌再灌注及梗死面积的关系。
我们研究了111例首次发生AMI且症状发作6小时内出现前侧壁ST段抬高、左前降支冠状动脉心肌梗死溶栓（TIMI）3级血流的患者。根据入院心电图上侧壁ST段抬高模式将患者分为两组：第1组，42例I导联ST段抬高等于或大于aVL导联的患者；第2组，69例I导联ST段抬高小于aVL导联的患者。出院前通过左心室造影测量左心室射血分数（LVEF）。
两组在年龄、性别、发病至再灌注时间、罪犯病变或侧支循环形成方面无差异。第1组患者再灌注后心肌 blush分级为0或1，提示心肌再灌注受损的可能性更高，肌酸激酶峰值水平更高，LVEF低于第2组患者（p分别为0.0001）。
我们得出结论，对于入院心电图表现为前侧壁ST段抬高且再灌注的AMI患者，I导联ST段抬高等于或大于aVL导联与心肌再灌注受损及心肌挽救较少有关。
