Huey B L, Beller G A, Kaiser D L, Gibson R S
Department of Internal Medicine, University of Virginia Medical Center, Charlottesville 22908.
J Am Coll Cardiol. 1988 Nov;12(5):1156-66. doi: 10.1016/0735-1097(88)92594-6.
Forty consecutive patients with creatine kinase-MB confirmed myocardial infarction due to circumflex artery occlusion (Group 1) were prospectively evaluated and compared with 107 patients with infarction due to right coronary artery occlusion (Group 2) and 94 with left anterior descending artery occlusion (Group 3). All 241 patients underwent exercise thallium-201 scintigraphy, radionuclide ventriculography, 24 h Holter electrocardiographic (ECG) monitoring and coronary arteriography before hospital discharge and were followed up for 39 +/- 18 months. There were no significant differences among the three infarct groups in age, gender, number of risk factors, prevalence and type of prior infarction, Norris index, Killip class and frequency of in-hospital complications. Acute ST segment elevation was present in only 48% of patients in Group 1 versus 71 and 72% in Groups 2 and 3, respectively (p = 0.012), and 38% of patients with a circumflex artery-related infarct had no significant ST changes (that is, elevation or depression) on admission (versus 21 and 20% for patients in Groups 2 and 3, respectively) (p = 0.001). Abnormal R waves in lead V1 were more common in Group 1 than in Group 2 (p less than 0.003) as was ST elevation in leads I, aVL and V4 to V6 (p less than or equal to 0.048). These differences in ECG findings between Group 1 and 2 patients correlated with a significantly higher prevalence of posterior and lateral wall asynergy in the group with a circumflex artery-related infarct. Infarct size based on peak creatine kinase levels and multiple radionuclide variables was intermediate in Group 1 compared with that in Group 2 (smallest) and Group 3 (largest). During long-term follow-up, the probability of recurrent cardiac events was similar in the three infarct groups. When patients with a circumflex artery-related infarct were stratified according to the presence or absence of abnormal R waves in lead V1 or V2, the abnormal R wave group had more admission ST elevation (p = 0.025), a larger infarct (p less than 0.05) and more extensive coronary artery disease (p = 0.027). In fact, all patients with a circumflex artery-related infarct and an abnormal R wave in lead V1 had multivessel disease. An abnormal R wave in lead V1 had a 96% specificity for circumflex versus right coronary artery-related infarction but a sensitivity of only 21%. Discriminate function analysis of all admission historical and ECG variables identified inferior and lateral ST elevation as independent predictors of circumflex artery-related infarction...
对40例因回旋支动脉闭塞确诊为心肌梗死的连续患者（第1组）进行前瞻性评估，并与107例因右冠状动脉闭塞导致梗死的患者（第2组）和94例因左前降支动脉闭塞导致梗死的患者（第3组）进行比较。所有241例患者在出院前均接受了运动铊-201心肌显像、放射性核素心室造影、24小时动态心电图（ECG）监测和冠状动脉造影，并随访39±18个月。三个梗死组在年龄、性别、危险因素数量、既往梗死的患病率和类型、诺里斯指数、Killip分级及住院并发症发生率方面无显著差异。第1组仅48%的患者出现急性ST段抬高，而第2组和第3组分别为71%和72%（p = 0.012），且38%的与回旋支动脉相关梗死的患者入院时无明显ST段改变（即抬高或压低）（第2组和第3组患者分别为21%和20%）（p = 0.001）。第1组V1导联异常R波比第2组更常见（p < 0.003），I、aVL及V4至V6导联ST段抬高情况也是如此（p≤0.048）。第1组和第2组患者的这些心电图表现差异与回旋支动脉相关梗死组后壁和侧壁运动失调的患病率显著更高相关。基于肌酸激酶峰值水平和多个放射性核素变量的梗死面积，第1组介于第2组（最小）和第3组（最大）之间。在长期随访中，三个梗死组复发性心脏事件的概率相似。当根据V1或V2导联是否存在异常R波对与回旋支动脉相关梗死的患者进行分层时，异常R波组入院时ST段抬高更多（p = 0.025），梗死面积更大（p < 0.05），冠状动脉疾病更广泛（p = 0.027）。实际上，所有V1导联有异常R波且与回旋支动脉相关梗死的患者均患有多支血管病变。V1导联异常R波对回旋支动脉与右冠状动脉相关梗死的特异性为96%，但敏感性仅为21%。对所有入院时的病史和心电图变量进行判别函数分析，发现下壁和侧壁ST段抬高是回旋支动脉相关梗死的独立预测因素……
