急性冠状动脉综合征患者aVR导联ST段抬高与冠状动脉病变

ST segment elevation in lead aVR and coronary artery lesions in patients with acute coronary syndrome.

作者信息

Rostoff Paweł, Piwowarska Wiesława

机构信息

Klinika Choroby Wieńcowej, Instytut Kardiologii, Collegium Medicum UJ, ul. Pradnicka 80, 31-202 Kraków.

出版信息

Kardiol Pol. 2006 Jan;64(1):8-14; discussion 15.

PMID:16444621

Abstract

INTRODUCTION

Recently, the prognostic value of ST segment elevation in lead aVR in acute coronary syndrome (ACS) and its relationship with significant stenosis of the left main coronary artery (LMCAS) and three-vessel disease have been highlighted.

AIM

Analysis of the relationship between ST segment elevation observed in aVR lead and angiographic severity of coronary artery disease in patients with ACS.

METHODS

The study involved 134 patients with ACS, including 54 subjects with ST elevation in aVR (group A) and 80 patients without elevation of ST in the same lead (group B), aged 33-78 years, mean 59.9+/-9.7 years. The severity of coronary artery disease was compared between the two groups. The logistic regression model was used for the analysis of factors affecting ST segment in aVR, as well as LMCAS and three-vessel disease probability.

RESULTS

In patients with ST elevation in aVR, three-vessel disease prevalence was two times higher (61.1% vs 35.0%; p <0.01), and LMCAS - three times higher (55.6% vs 17.5%; p <0.000001) than in those without ST elevation in aVR. Factors independently associated with ST elevation in aVR were LMCAS (OR 6.1; 95% CI 2.62-14.23; p <0.00005), ST segment elevation in V1 (OR 3.03; 95% CI 1.34-6.86; p <0.01) and diabetes (OR 2.89; 95% CI 1.17-7.15; p <0.05). The predictors of LMCAS were three-vessel disease and ST elevation in aVR, while the predictors of three-vessel disease were: LMCAS, diabetes, male gender and history of myocardial infarction.

CONCLUSIONS

Elevation of the ST segment in aVR in the setting of acute coronary syndrome identifies patients with severe coronary artery disease. Only left main coronary artery disease, however, remains independently associated with ST segment elevation in aVR. Three-vessel disease and the left main coronary artery stenosis equivalent are not independent predictors of ST segment elevation in aVR of standard electrocardiograms recorded in patients with acute coronary syndrome.

摘要

引言

最近，急性冠脉综合征（ACS）中aVR导联ST段抬高的预后价值及其与左主干冠状动脉严重狭窄（LMCAS）和三支血管病变的关系受到了关注。

目的

分析ACS患者aVR导联观察到的ST段抬高与冠状动脉疾病血管造影严重程度之间的关系。

方法

该研究纳入了134例ACS患者，其中54例aVR导联ST段抬高（A组），80例同一导联ST段未抬高（B组），年龄33 - 78岁，平均59.9±9.7岁。比较两组之间冠状动脉疾病的严重程度。采用逻辑回归模型分析影响aVR导联ST段以及LMCAS和三支血管病变概率的因素。

结果

aVR导联ST段抬高的患者中，三支血管病变患病率比未抬高者高两倍（61.1%对35.0%；p<0.01），LMCAS患病率高三倍（55.6%对17.5%；p<0.000001）。与aVR导联ST段抬高独立相关的因素有LMCAS（比值比6.1；95%置信区间2.62 - 14.23；p<0.00005）、V1导联ST段抬高（比值比3.03；95%置信区间1.34 - 6.86；p<0.01）和糖尿病（比值比2.89；95%置信区间1.17 - 7.15；p<0.05）。LMCAS的预测因素是三支血管病变和aVR导联ST段抬高，而三支血管病变的预测因素是：LMCAS、糖尿病、男性性别和心肌梗死病史。