Pourafkari Leili, Tajlil Arezou, Mahmoudi Seyed Sajjad, Ghaffari Samad
Cardiovascular Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.
Ann Noninvasive Electrocardiol. 2016 Jul;21(4):389-96. doi: 10.1111/anec.12324. Epub 2015 Nov 2.
Identifying infarct-related artery (IRA) in patients with inferior ST elevation myocardial infarction (STEMI) has prognostic and therapeutic benefits.
To differentiate IRA and the location of culprit lesion in inferior STEMI, using ST segment changes in lead aVR.
ST segment changes in lead aVR were recorded in 150 patients, admitted with first inferior STEMI. The association of IRA and the location of culprit lesion with ST segment changes in aVR were investigated.
ST elevation ≥ 0.5 mm in lead aVR was present in 17 patients (11.3%), ST depression ≥ 0.5 mm in 74 patients (49.3%) and 59 patients (39.3%) did not have significant ST segment changes. Right coronary artery (RCA) was the IRA in 117 patients (78%) and left circumflex artery (LCX) in 33 patients (22%). Prevalence of RCA involvement as the IRA was different in three study groups (94.1% in ST elevation group, 83.1% in isoelectric group and 70.3% in ST depression group, P = 0.049). Presence of ST elevation had a sensitivity and specificity of 13.68 % and 96.97%, for detecting RCA lesions, respectively. ST depression had 66.67% sensitivity and 55.56% specificity for identifying LCX lesions. Clinical complications were low in our study with no significant difference among patients of three groups.
Presence of ST elevation is highly suggestive of RCA lesions versus LCX lesions, whereas absence of ST elevation cannot rule out RCA lesions. Presence of ST depression has a moderate sensitivity and specificity for LCX lesions.
识别下壁ST段抬高型心肌梗死（STEMI）患者的梗死相关动脉（IRA）具有预后和治疗意义。
利用aVR导联的ST段变化鉴别下壁STEMI患者的IRA及罪犯病变位置。
记录150例首次因下壁STEMI入院患者aVR导联的ST段变化。研究IRA及罪犯病变位置与aVR导联ST段变化的相关性。
17例患者（11.3%）aVR导联ST段抬高≥0.5mm，74例患者（49.3%）ST段压低≥0.5mm，59例患者（39.3%）无明显ST段变化。117例患者（78%）IRA为右冠状动脉（RCA），33例患者（22%）为左旋支动脉（LCX）。三个研究组中，RCA作为IRA受累的患病率不同（ST段抬高组为94.1%，等电位组为83.1%，ST段压低组为70.3%，P = 0.049）。ST段抬高对检测RCA病变的敏感性和特异性分别为13.68%和96.97%。ST段压低对识别LCX病变的敏感性为66.67%，特异性为55.56%。本研究中临床并发症发生率较低，三组患者之间无显著差异。
ST段抬高高度提示为RCA病变而非LCX病变，而ST段未抬高不能排除RCA病变。ST段压低对LCX病变具有中等的敏感性和特异性。
