Hiasa Y, Morimoto S, Wada T, Hamai K, Nakaya Y, Mori H
Department of Cardiology, Komatsushima Red Cross Hospital, Tokushima, Japan.
Clin Cardiol. 1990 Nov;13(11):783-8. doi: 10.1002/clc.4960131107.
To distinguish between acute occlusion of the right coronary artery (RCA) and the left circumflex artery (LCx) by electrocardiography, we studied ST-segment deviation during balloon inflation in percutaneous transluminal angioplasty. The composite electrocardiographic criteria based on ST-segment deviations increased the diagnostic specificity: that is, the finding of inferior infarction (ST-segment elevation in leads II, III, aVF) without lateral infarction (ST-segment elevation in leads V5,6) was highly suggestive of RCA occlusion (sensitivity and specificity: 35 of 43 cases, 81.4%; and 33 of 36 cases, 91.7%), whereas ST-segment elevation in leads V5,6 (LCx: 23 of 36 cases; 63.9%, RCA: 5 of 43 cases; 11.6%) or isolated ST-segment depression in leads V2-4 (LCx: 9 of 36 cases; 25.0%, RCA: none of 43 cases) was highly suggestive of LCx occlusion. These results indicate that the composite electrocardiographic criteria were useful in predicting the artery involved in acute myocardial infarction, although any single criterion was not sensitive or specific enough to differentiate right from left circumflex coronary artery occlusion.
为了通过心电图区分右冠状动脉（RCA）和左旋支动脉（LCx）的急性闭塞，我们研究了经皮腔内血管成形术球囊扩张期间的ST段偏移。基于ST段偏移的综合心电图标准提高了诊断特异性：即，发现下壁梗死（II、III、aVF导联ST段抬高）而无侧壁梗死（V5、V6导联ST段抬高）高度提示RCA闭塞（敏感性和特异性：43例中的35例，81.4%；36例中的33例，91.7%），而V5、V6导联ST段抬高（LCx：36例中的23例；63.9%，RCA：43例中的5例；11.6%）或V2 - 4导联孤立性ST段压低（LCx：36例中的9例；25.0%，RCA：43例中无）高度提示LCx闭塞。这些结果表明，综合心电图标准有助于预测急性心肌梗死累及的动脉，尽管任何单一标准都不足以敏感或特异地区分右冠状动脉和左旋支冠状动脉闭塞。
