Koju Rajendra, Islam Nazrul, Rahman Afzalur, Mohsin Khaled, Ali Ahtar, Islam Mazharul, Yadav Chandeshwar
Department of Cardiology, Dhulikhel Hospital, PO No. 11008, 011-661497, 011-661727, Dhaka, Bangladesh.
Nepal Med Coll J. 2003 Dec;5(2):64-8.
The complications, therapy and prognosis are significantly determined by the exact location of occlusion site in left anterior descending (LAD) coronary artery in anterior acute myocardial infarction (AMI). This study assessed the role of Electrocardiogram (ECG) as a predictor of coronary artery occlusion site in anterior AMI. Sixty two patients of anterior AMI were divided into two groups according to the occlusion site in relation to first septal and first diagonal branches, proximal--group A and distal--group B. Their initial ECG were analyzed and interpreted. The number of patients having ST elevation in leads aVR and aVL (> or = 0.5 mm) were significantly higher in proximal group compared to distal ones (42.3% vs 2.8% and 73.1% vs 22.2%; p < 0.001). Similarly the number of patients having ST depression in inferior leads, II (> or = 1 mm), III (> or = 1 mm) and aVF (> or = 1 mm) were also significantly higher in proximal group (84.6% vs 22.2%, 88.5% vs 33.3% and 84.6% vs 22.2%; p < 0.001). The sensitivity of ST depression in inferior leads II (> or = 1 mm), III (> or = 1 mm) and aVF (> or = 1 mm) to predict the proximal lesion were 85.0%, 88.0% and 85.0% respectively, whereas specificity were 78.0%, 67.0% and 78.0% respectively. The ST elevation in a VR had 42.0% sensitivity and 97.0% specificity to predict proximal lesion. Similarly ST elevation in aVL (> or = 0.5 mm) had 73% sensitivity and 78% specificity. In anterior AMI, ST elevation in aVR, aVL and ST depression in inferior leads can predict the occlusion site in LAD proximal to first diagonal and first septal branch.
在前壁急性心肌梗死（AMI）中，并发症、治疗及预后情况很大程度上取决于左前降支（LAD）冠状动脉闭塞部位的精确位置。本研究评估了心电图（ECG）在前壁AMI中作为冠状动脉闭塞部位预测指标的作用。62例前壁AMI患者根据闭塞部位与第一间隔支和第一对角支的关系分为两组，近端组为A组，远端组为B组。对他们的初始心电图进行分析和解读。近端组中aVR和aVL导联ST段抬高（≥0.5 mm）的患者数量显著高于远端组（42.3% 对2.8%以及73.1% 对22.2%；p<0.001）。同样，近端组在下壁导联II（≥1 mm）、III（≥1 mm）和aVF（≥1 mm）出现ST段压低的患者数量也显著更高（84.6% 对22.2%、88.5% 对33.3%以及84.6% 对22.2%；p<0.001）。下壁导联II（≥1 mm）、III（≥1 mm）和aVF（≥1 mm）ST段压低预测近端病变的敏感性分别为85.0%、88.0%和85.0%，而特异性分别为78.0%、67.0%和78.0%。aVR导联ST段抬高预测近端病变的敏感性为42.0%，特异性为97.0%。同样，aVL导联ST段抬高（≥0.5 mm）的敏感性为73%，特异性为78%。在前壁AMI中，aVR、aVL导联ST段抬高以及下壁导联ST段压低可预测第一对角支和第一间隔支近端LAD的闭塞部位。
