Bolca Osman, Eren Mehmet, Akdemir Osman, Yildirim Aydin, Dağdeviren Bahadir, Tezel Tuna
Siyami Ersek Thoracic and Cardiovascular Surgery Center, Department of Cardiology, Istanbul, Turkey.
Angiology. 2004 Nov-Dec;55(6):679-83. doi: 10.1177/00033197040550i609.
The predictive accuracy of electrocardiographic markers in identifying the infarct-related artery of myocardial infarctions has been a subject of extensive investigation. The present study was designed to test whether the index L II/L III ratio adapted to exercise electrocardiograms could be utilized as a marker to distinguish right coronary and left circumflex arteries as culprit coronaries in acute inferior myocardial infarctions. For this purpose, 82 patients with a positive-symptom-limited and/or submaximal treadmill exercise test with modified Bruce protocol after an acute inferior myocardial infarction were studied. Those patients with ST segment elevation during the stress test were included in the study. ST segment index was defined as the ratio of exercise-induced ST elevation amplitude in L II/L III. Patients were classified as having an index > 1 (n=24) and < 1 (n=58), and the findings were compared with the findings on coronary angiography. The groups were comparable with respect to age, gender, peak exercise level, and double products achieved. Circumflex artery was the infarct-related one in the majority (21/24; 88%) of patients with an index > 1, whereas most (51/58; 88%) patients with an index < 1 had the culprit lesion in their right coronary artery (p<0.001). The ratio of exercise-induced ST elevations in leads L II and L III has a significantly high ability to discriminate the infarct-related coronary artery in patients with uncomplicated inferior myocardial infarction. Considering the prognostic importance of the type of coronary involvement, this index could be a part of predischarge evaluation in this patient group.
心电图标志物在识别心肌梗死相关梗死动脉方面的预测准确性一直是广泛研究的课题。本研究旨在测试适用于运动心电图的L II/L III比值能否作为区分急性下壁心肌梗死中作为罪犯冠状动脉的右冠状动脉和左旋支动脉的标志物。为此，对82例急性下壁心肌梗死后进行症状受限和/或次极量平板运动试验（采用改良Bruce方案）呈阳性的患者进行了研究。应激试验期间出现ST段抬高的患者纳入研究。ST段指数定义为运动诱发的L II/L III导联ST段抬高幅度的比值。患者分为指数>1（n=24）和<1（n=58）两组，并将结果与冠状动脉造影结果进行比较。两组在年龄、性别、运动峰值水平和达到的双乘积方面具有可比性。指数>1的患者中，大多数（21/24；88%）的梗死相关动脉为左旋支动脉，而指数<1的患者中，大多数（51/58；88%）的罪犯病变位于右冠状动脉（p<0.001）。L II和L III导联运动诱发的ST段抬高比值在鉴别无并发症下壁心肌梗死患者梗死相关冠状动脉方面具有显著的高能力。考虑到冠状动脉受累类型的预后重要性，该指数可作为该患者群体出院前评估的一部分。
