Forselv Gabriel Christian, Vik-Mo Harald
Det medisinske fakultet, Norges teknisk-naturvitenskapelige universitet, Trondheim.
Tidsskr Nor Laegeforen. 2007 Sep 6;127(17):2230-2.
Patients with acute coronary syndrome without ST-segment elevation in ECG have a serious prognosis with increased risk of a new myocardial infarction and death. The prognosis depends on the artery involved.
The value of ECG at rest for detection of proximal stenosis in the left descending coronary artery (LAD) was evaluated prospectively in 138 consecutive patients with acute coronary syndrome without ST-segment elevation.
Negative or biphasic T-wave in lead V 2-V 3 was observed in 31/138 (22%) patients. Ichemia-related stenosis in proximal LAD was found in 25/138 (18%) patients. Negative or biphasic T-wave in V 2-V 3 was observed more often in patients with ischemia-related LAD stenosis than in other patients (76% versus 11%, p < 0.01). Troponin T or clinical risk score did not identify patients with ischemia-related LAD stenosis.
A biphasic or negative T-wave in lead V 2-V 3 can be used as a reliable method to diagnose proximal LAD stenosis in acute coronary syndrome, and should be used as a selection criterion for referral of patients to urgent coronary angiography and intervention.
心电图无ST段抬高的急性冠状动脉综合征患者预后严重，新发心肌梗死和死亡风险增加。预后取决于受累动脉。
前瞻性评估138例连续的心电图无ST段抬高的急性冠状动脉综合征患者静息心电图对检测左前降支近端狭窄的价值。
138例患者中有31例（22%）在V2-V3导联出现负向或双向T波。138例患者中有25例（18%）发现左前降支近端存在缺血相关狭窄。左前降支缺血相关狭窄患者V2-V3导联出现负向或双向T波的比例高于其他患者（76%对11%，p<0.01）。肌钙蛋白T或临床风险评分无法识别左前降支缺血相关狭窄患者。
V2-V3导联双向或负向T波可作为诊断急性冠状动脉综合征左前降支近端狭窄的可靠方法，应用于筛选患者进行紧急冠状动脉造影和介入治疗。
