Department of Cardiology, Shanxi Cardiovascular Hospital, Taiyuan, China.
Department of Cardiology, Xinxiang Central Hospital, Henan, China.
Sci Rep. 2024 Nov 24;14(1):29112. doi: 10.1038/s41598-024-80313-5.
In determining the culprit vessel responsible for inferior ST-segment elevation myocardial infarction (STEMI) as either the right coronary artery (RCA) or left circumflex (LCX), the electrocardiographic value has been validated. However, its ability to predict whether inferior STEMI is complicated by left anterior descending artery (LAD) chronic total occlusion remains uncertain. Based on the involvement of arteries other than the culprit vessels, 189 patients with inferior STEMI from our chest pain center were categorized into four groups: LAD occlusion group (n = 20), LAD stenosis > 50% group (n = 116), normal LAD group (n = 27), and other vessel stenosis > 50% group (n = 26). All groups underwent coronary angiography within 24 h of admission, and electrocardiogram (ECG) and clinical data were retrospectively analyzed. In the LAD occlusion group, hypertension was significantly more prevalent (P = 0.015). Although there was a trend toward higher previous cerebral infarction and lower diabetes prevalence in the Normal LAD group, neither was statistically significant (P = 0.070 and P = 0.088). The LAD occlusion group demonstrated the highest serum N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels and the most reduced LVEF, with a higher susceptibility to cardiogenic shock (P < 0.01). This group also had a higher use of intra-aortic balloon pump (IABP) and a greater occurrence of ventricular fibrillation or tachycardia compared to the other groups (P < 0.05). The QRS duration in lead V4 (QRS ) was 99.4 ± 19.1 ms in the LAD occlusion group, 87.5 ± 14.9 ms in the LAD stenosis group, 89.6 ± 11.4 ms in the normal LAD group, and 87.7 ± 11.7 ms in the other vessel stenosis group (P = 0.010). The difference between ST-segment depression in V4 and ST-segment elevation in lead III (ST ↓- ST ↑) in the LAD occlusion group was the largest at -0.06 (-1.19, 1.05) mm (P = 0.029). ROC curve analysis revealed that the sensitivity of QRS > 97.7ms and ST ↓- ST ↑> 0 mm diagnosing inferior STEMI complicated with LAD occlusion was 54.5% and 50%, with a specificity of 75.1% and 78.0%, respectively. Multivariate logistic regression analysis indicated that QRS (OR = 1.062, P = 0.003), ST ↓- ST ↑ (OR = 1.641, P = 0.050), and Killip classification (OR = 2.115, P = 0.004) were all independent risk factors for LAD occlusion. In patients with inferior STEMI complicated by LAD occlusion without anterior myocardial infarction, cardiac function is poorer. The ST-segment deviation between the leads V4 and III, and the duration of QRS in the lead V4, can aid in diagnosis.
在确定导致下壁 ST 段抬高型心肌梗死（STEMI）的罪犯血管是右冠状动脉（RCA）还是左回旋支（LCX）时，心电图的价值已经得到验证。然而，其预测下壁 STEMI 是否并发左前降支（LAD）慢性完全闭塞的能力仍不确定。根据罪犯血管以外的动脉受累情况，我们胸痛中心的 189 例下壁 STEMI 患者分为四组：LAD 闭塞组（n=20）、LAD 狭窄>50%组（n=116）、正常 LAD 组（n=27）和其他血管狭窄>50%组（n=26）。所有患者均在入院后 24 小时内行冠状动脉造影，回顾性分析心电图（ECG）和临床资料。在 LAD 闭塞组中，高血压的发生率明显更高（P=0.015）。虽然在正常 LAD 组中，既往脑梗死发生率较高，糖尿病发生率较低，但差异无统计学意义（P=0.070 和 P=0.088）。LAD 闭塞组的血清 N 末端脑钠肽前体（NT-proBNP）水平最高，LVEF 最低，对心源性休克的易感性更高（P<0.01）。与其他组相比，该组还更倾向于使用主动脉内球囊反搏（IABP），且更易发生室颤或室速（P<0.05）。LAD 闭塞组 V4 导联 QRS 时限为 99.4±19.1ms，LAD 狭窄组为 87.5±14.9ms，正常 LAD 组为 89.6±11.4ms，其他血管狭窄组为 87.7±11.7ms（P=0.010）。LAD 闭塞组 V4 导联 ST 段压低（ST↓）与 III 导联 ST 段抬高（ST↑）之间的差值最大为-0.06（-1.19，1.05）mm（P=0.029）。ROC 曲线分析显示，QRS>97.7ms 和 ST↓-ST↑>0mm 诊断下壁 STEMI 并发 LAD 闭塞的灵敏度分别为 54.5%和 50%，特异性分别为 75.1%和 78.0%。多变量 logistic 回归分析表明，QRS（OR=1.062，P=0.003）、ST↓-ST↑（OR=1.641，P=0.050）和 Killip 分级（OR=2.115，P=0.004）均是 LAD 闭塞的独立危险因素。在并发 LAD 闭塞但无前壁心肌梗死的下壁 STEMI 患者中，心功能较差。V4 和 III 导联之间的 ST 段偏移以及 V4 导联的 QRS 时限有助于诊断。
