急性心肌梗死单支血管病变患者心电图改变与冠状动脉病变的相关性
Correlation between electrocardiographic changes and coronary findings in patients with acute myocardial infarction and single-vessel disease.
作者信息
Sanaani Abdallah, Yandrapalli Srikanth, Jolly George, Paudel Rajiv, Cooper Howard A, Aronow Wilbert S
机构信息
Division of Cardiology, Westchester Medical Center, New York Medical College, Valhalla, NY, USA.
Department of Internal Medicine, Westchester Medical Center, New York Medical College, Valhalla, NY, USA.
出版信息
Ann Transl Med. 2017 Sep;5(17):347. doi: 10.21037/atm.2017.06.33.
BACKGROUND
Correlation of ST-segment elevation on the 12-lead electrocardiogram (ECG) with the expected affected coronary territory is established in patients with ST-elevation myocardial infarction (STEMI). In patients with non-ST-elevation myocardial infarction (NSTEMI), correlation of ischemic ECG abnormalities with the affected coronary territory has not been well-established. We sought to investigate the correlation of electrocardiographic abnormalities with the location of 1-vessel obstructive coronary artery disease (CAD) in patients with both STEMI and NSTEMI.
METHODS
In this retrospective study, the charts of all patients referred for coronary angiography in 2012 were reviewed. Patients with a single obstructive coronary artery plus angina-equivalent symptoms and an elevated cardiac troponin I was included. Available ECGs were interpreted by an experienced cardiologist (WSA) blinded to the result of angiography. Patients with complete bundle branch block or ventricular pacing were excluded. Ischemic ECG changes were correlated to a coronary territory based on predefined criteria.
RESULTS
Of 131 included patients (mean age 64±13 years; 74% male), 29 had STEMI and 102 had NSTEMI. Eleven of 11 patients (100%) with anterior STEMI had left anterior descending artery (LAD) obstructive CAD. Of 18 patients with inferior STEMI, 14 (78%) had right coronary artery (RCA) obstructive CAD, 3 (17%) had left circumflex artery (LCX) artery obstructive CAD, and 1 (5%) had LAD obstructive CAD. Of 102 NSTEMI patients, 53 (52%) had definite ECG ischemic abnormalities. Of 31 patients with anterior definite ECG ischemic abnormalities, 30 (97%) had LAD obstructive CAD, and 1 (3%) had RCA obstructive CAD. Of 22 patients with inferior definite ECG ischemic abnormalities, 14 (64%) had RCA obstructive CAD, 5 (23%) had LCX obstructive CAD, and 3 (14%) had LAD obstructive CAD.
CONCLUSIONS
Patients with anterior STEMI had LAD obstructive CAD. Patients with inferior STEMI were highly likely to have RCA or LCX obstructive CAD. Only half of NSTEMI patients had definite ischemic ECG abnormalities. When present, anterior ischemic ECG changes in patients with single vessel CAD with NSTEMI were predictive of LAD obstructive CAD.
背景
ST段抬高型心肌梗死（STEMI）患者中，12导联心电图（ECG）上ST段抬高与预期受影响的冠状动脉区域之间的相关性已得到确立。在非ST段抬高型心肌梗死（NSTEMI）患者中，缺血性ECG异常与受影响的冠状动脉区域之间的相关性尚未完全确立。我们旨在研究STEMI和NSTEMI患者心电图异常与单支血管阻塞性冠状动脉疾病（CAD）部位之间的相关性。
方法
在这项回顾性研究中，我们查阅了2012年所有接受冠状动脉造影患者的病历。纳入单支冠状动脉阻塞且有等效心绞痛症状及心肌肌钙蛋白I升高的患者。由一位对血管造影结果不知情的经验丰富的心脏病专家（WSA）解读可用的ECG。排除完全性束支传导阻滞或心室起搏患者。根据预定义标准，将缺血性ECG改变与冠状动脉区域相关联。
结果
在纳入的131例患者（平均年龄64±13岁；74%为男性）中，29例为STEMI，102例为NSTEMI。11例前壁STEMI患者中有11例（100%）存在左前降支（LAD）阻塞性CAD。18例下壁STEMI患者中，14例（78%）存在右冠状动脉（RCA）阻塞性CAD，3例（17%）存在左旋支（LCX）阻塞性CAD，1例（5%）存在LAD阻塞性CAD。102例NSTEMI患者中，53例（52%）有明确的ECG缺血性异常。31例前壁明确ECG缺血性异常患者中，30例（97%）存在LAD阻塞性CAD，1例（3%）存在RCA阻塞性CAD。22例下壁明确ECG缺血性异常患者中，14例（64%）存在RCA阻塞性CAD，5例（23%）存在LCX阻塞性CAD，3例（14%）存在LAD阻塞性CAD。
结论
前壁STEMI患者存在LAD阻塞性CAD。下壁STEMI患者极有可能存在RCA或LCX阻塞性CAD。只有一半的NSTEMI患者有明确的缺血性ECG异常。对于单支血管CAD的NSTEMI患者，若存在前壁缺血性ECG改变，则提示LAD阻塞性CAD。
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