Gaballa Ayman, Farid Wala, Al-Kersh Ahmad, Rajan Rajesh, Al Jarallah Mohammed
Department of Cardiology, Sabah Al-Ahmad Cardiac Center, Al-Amiri Hospital, Kuwait.
Department of Cardiology, Faculty of Medicine, Menoufia University, Egypt.
J Electrocardiol. 2019 Jan-Feb;52:59-62. doi: 10.1016/j.jelectrocard.2018.10.094. Epub 2018 Oct 30.
Isolation of infract related artery and timely revascularisation remains vital in the setting of primary percutaneous coronary intervention.
To analyse the predictive value of ST-T changes in lead aVR in inferior myocardial infarction in terms of prognosis and timely risk stratification.
We conducted a prospective analysis of acute inferior wall myocardial infarction patients. One hundred patients were categorised into two groups according to the culprit artery: group I, right coronary artery (RCA) and group II, left circumflex coronary artery (LCX), with 50 patients in each group. A comparative study was performed between the two groups, comprising the following data outputs: electrocardiogram (ECG) changes that could help determine the culprit artery, cardiac enzyme levels, echocardiographic findings, coronary angiography findings and in-hospital complications. The same patients were divided into two groups according to the presence or absence of 1 mm ST depression in lead aVR. A comparison analysis was performed between the two groups including: cardiac enzyme levels, echocardiographic findings, coronary angiography findings and in-hospital complications.
ST depression in aVR ≥ 1 mm predicted the LCX as a culprit artery with sensitivity, specificity, positive predictive values (PPV) and negative predictive values (NPV) recorded at 66%, 84%, 80.5% and 71.2%, respectively. Also, patients with ST depression in aVR ≥ 1 mm showed significantly higher cardiac enzyme levels, indicating larger infarct size, with mean peak creatinine kinase (CK) = 1560 (1057-2375) IU/L versus 970 (613-1683) IU/L, (P value = 0.014), lower ejection fraction (Ef) with mean Ef = 47.93 ± 8.04 versus 54.66 ± 6.52, (P value < 0.001) and more significant mitral regurgitation: 17 (41.5%) patients versus 11 (18.6%) patients (P value = 0.012). Regarding in-hospital complications, there were no significant differences.
ST depression of >1 mm in lead aVR predicts LCX as the infarct related artery and is a predictor of poor outcome in patients with inferior myocardial infarction.
在直接经皮冠状动脉介入治疗中，梗死相关动脉的分离及及时的血管重建仍然至关重要。
分析aVR导联ST-T改变在下壁心肌梗死预后及及时风险分层方面的预测价值。
我们对急性下壁心肌梗死患者进行了一项前瞻性分析。100例患者根据罪犯血管分为两组：I组，右冠状动脉（RCA）；II组，左旋支冠状动脉（LCX），每组各50例。对两组进行了一项对比研究，包括以下数据输出：有助于确定罪犯血管的心电图（ECG）改变、心肌酶水平、超声心动图检查结果、冠状动脉造影结果及院内并发症。同一批患者根据aVR导联是否存在1mm ST段压低分为两组。对两组进行了对比分析，包括：心肌酶水平、超声心动图检查结果、冠状动脉造影结果及院内并发症。
aVR导联ST段压低≥1mm预测LCX为罪犯血管，其敏感性、特异性、阳性预测值（PPV）和阴性预测值（NPV）分别为66%、84%、80.5%和71.2%。此外，aVR导联ST段压低≥1mm的患者心肌酶水平显著更高，表明梗死面积更大，平均肌酸激酶（CK）峰值=1560（1057 - 2375）IU/L，而另一组为970（613 - 1683）IU/L，（P值=0.014），射血分数（Ef）更低，平均Ef=47.93±8.04，而另一组为54.66±6.52，（P值<0.001），二尖瓣反流更显著：17例（41.5%）患者，而另一组为11例（18.6%）患者（P值=0.012）。关于院内并发症，无显著差异。
aVR导联ST段压低>1mm预测LCX为梗死相关动脉，是下壁心肌梗死患者预后不良的一个预测指标。
