Internal Medicine, Faculty of Medicine, Oita University, Yufu, Japan.
Am J Cardiol. 2011 Sep 1;108(5):625-9. doi: 10.1016/j.amjcard.2011.04.007. Epub 2011 Jun 14.
Previous studies have shown that the analysis of ST-segment deviation in lead aVR on admission provides useful information on angiographic coronary anatomy and risk stratification in acute coronary syndromes. However, the association between ST-segment deviation in lead aVR on admission and left ventricular (LV) function has not been fully investigated in anterior wall acute ST-segment elevation myocardial infarction. In this study, 237 patients with first anterior wall acute ST-segment elevation myocardial infarction were examined. The patients were divided into the following 3 groups according to ST-segment deviation in lead aVR on admission: 85 with ST-segment elevation ≥0.5 mm (group A), 106 without ST-segment deviation (group B), and 46 with ST-segment depression ≥0.5 mm (group C). LV ejection fractions at predischarge were compared among the 3 groups. Among the 3 groups, there were significant differences in the prevalences of proximal left anterior descending coronary artery (LAD) occlusion (group A 75.3%, group B 56.6%, group C 45.7%, p = 0.002), long LAD (group A 27.1%, group B 31.1%, group C 56.5%, p = 0.002), and good collaterals to the LAD (group A 40.0%, group B 25.4%, group C 17.4%, p = 0.01). LV ejection fractions at predischarge did not differ among the 3 groups (group A 56.4 ± 12.5%, group B 56.9 ± 12.7%, group C 53.3 ± 12.2%, p = 0.26). On a multiple regression analysis, establishment of Thrombolysis In Myocardial Infarction grade 3 flow, proximal LAD occlusion, and long LAD were associated with the LV ejection fraction at predischarge. In conclusion, ST-segment deviation in lead aVR on admission is not associated with LV function at predischarge in first anterior wall acute ST-segment elevation myocardial infarction.
先前的研究表明，入院时 aVR 导联 ST 段偏移的分析可为急性冠状动脉综合征的血管造影冠状动脉解剖和危险分层提供有用信息。然而，入院时 aVR 导联 ST 段偏移与前壁急性 ST 段抬高型心肌梗死左心室（LV）功能之间的关系尚未得到充分研究。在这项研究中，检查了 237 例首次前壁急性 ST 段抬高型心肌梗死患者。根据入院时 aVR 导联 ST 段偏移，将患者分为以下 3 组：ST 段抬高≥0.5mm 85 例（A 组），无 ST 段偏移 106 例（B 组），ST 段压低≥0.5mm 46 例（C 组）。比较 3 组患者出院时的左心室射血分数。在 3 组中，近端左前降支冠状动脉（LAD）闭塞的患病率（A 组 75.3%，B 组 56.6%，C 组 45.7%，p=0.002）、LAD 长段（A 组 27.1%，B 组 31.1%，C 组 56.5%，p=0.002）和 LAD 良好侧支（A 组 40.0%，B 组 25.4%，C 组 17.4%，p=0.01）有显著差异。3 组出院时的左心室射血分数无差异（A 组 56.4±12.5%，B 组 56.9±12.7%，C 组 53.3±12.2%，p=0.26）。多元回归分析显示，溶栓治疗心肌梗死 3 级血流、近端 LAD 闭塞和 LAD 长段与出院时的左心室射血分数相关。结论：在首次前壁急性 ST 段抬高型心肌梗死中，入院时 aVR 导联 ST 段偏移与出院时的左心室功能无关。
