[心电图对急性心肌梗死患者冠状动脉病变定位及范围诊断的贡献]

[Contribution of the electrocardiogram to the diagnosis of localization and extension of coronary lesions in patients with acute myocardial infarct].

作者信息

Farto e Abreu P, Gil V, Silva J A, Gomes R S

机构信息

Serviço de Cardiologia, Hospital de Santa Cruz.

出版信息

Rev Port Cardiol. 1992 Feb;11(2):127-38.

PMID:1567635

Abstract

UNLABELLED

With the purpose of evaluating the contribution of the ECG to the localization and extension of coronary artery lesions, 85 patients with the first acute myocardial infarction treated with thrombolysis, 79 males and 6 females (mean age 53.9 years), were studied, and the ECG changes at 3.5 and 24 hours correlated with the coronary angiographic findings before discharge. Patients were divided in two groups--Group A with anterior infarction (48 pts) and Group B with inferior infarction (37 pts).

RESULTS

A) Returning of the ST downslope to baseline in inferior and anterior leads, respectively in anterior and inferior infarction at 24 h ECG, excluded associated LAD or RCA/CX lesions with a sensitivity (S) of 93% and 87% and aspecificity (E) of 60% and 58%, with a positive predictive value (PPV) of 62% and 77% and a negative predictive value of 86% and 85% respectively. All patients with anterior infarction had LAD stenosis. B) ST upslope bigger than 5 mm in V2-V3 or its presence in D-I or aVL associated to any precordial leads, diagnosed proximal LAD lesions with S of 82% and 73% and E of 75% and 73% respectively. The left axis deviation was present in 6 of 7 patients and pointed to proximal lesion. C) In Group B patients, RCA lesion was related to ST downslope in D-I, S = 77%, E = 37.5%, PVV = 80% and NPV = 33.5%, and the proximal localization (ratio between ST downslope in V2 and ST upslope in aVF) inferior to 0.5 mm with S and NPV = 80% and E and PPV = 100%. The presence of an isoelectrical ST in D-I in association with ST upslope in V5-V6 is related to CX with S and NPV = 100%, E = 85% and PPV = 25%. In conclusion, these results suggest that a careful analysis of ECG changes in patients with first acute myocardial infarction, can provide important information regarding the infarct related artery, localization of the stenosis and the presence of associated coronary artery disease, with implications in the risk stratification before hospital discharge.

摘要

未标注

为评估心电图对冠状动脉病变定位及范围的贡献，对85例接受溶栓治疗的首次急性心肌梗死患者进行了研究，其中男性79例，女性6例（平均年龄53.9岁），分析了患者在3.5小时和24小时时的心电图变化，并与出院前的冠状动脉造影结果进行关联。患者分为两组——A组为前壁梗死患者（48例），B组为下壁梗死患者（37例）。

结果

A）在24小时心电图检查时，下壁梗死患者下壁导联及前壁梗死患者前壁导联ST段下降斜率恢复至基线水平，排除相关左前降支（LAD）或右冠状动脉/回旋支（RCA/CX）病变的敏感性（S）分别为93%和87%，特异性（E）分别为60%和58%，阳性预测值（PPV）分别为62%和77%，阴性预测值分别为86%和85%。所有前壁梗死患者均有LAD狭窄。B）V2 - V3导联ST段上升斜率大于5mm，或其在D - I或aVL导联与任何胸前导联同时出现，诊断近端LAD病变的敏感性分别为82%和73%，特异性分别为75%和73%。7例患者中有6例出现左轴偏移，提示近端病变。C）在B组患者中，RCA病变与D - I导联ST段下降相关，敏感性（S）= 77%，特异性（E）= 37.5%，阳性预测值（PVV）= 80%，阴性预测值（NPV）= 33.5%；V2导联ST段下降与aVF导联ST段上升之比小于0.5mm时，敏感性和阴性预测值均为80%，特异性和阳性预测值均为100%。D - I导联等电位ST段与V5 - V6导联ST段上升同时出现与CX相关，敏感性和阴性预测值均为100%，特异性为85%，阳性预测值为25%。总之，这些结果表明，对首次急性心肌梗死患者的心电图变化进行仔细分析，可为梗死相关动脉、狭窄部位及相关冠状动脉疾病的存在提供重要信息，对出院前的风险分层具有重要意义。