Prieto-Solis J A
Unidad Coronaria Hospital Universitario Marqués de Valdecilla, Santander, Spain.
Angiology. 1995 Oct;46(10):885-94. doi: 10.1177/000331979504601003.
In order to evaluate electrocardiographic changes in the diagnosis of the artery responsible for inferior myocardial infarction, a prospective study was performed on inferior and V2 ST segment deviation and its correlation using the arithmetic sum: II + V2, III + V2, and aVF + V2. A group of 66 patients with inferior acute myocardial infarction (AMI) was studied. A standard 12-leads electrocardiogram was performed within six hours of the onset of chest pain. Coronary arteriography was performed on each of the patients between one and twelve weeks after infarction. Right coronary artery (RCA) lesion was found in 46 patients, 27 at a proximal level and 19 at a distal level; in 20 patients the left circumflex coronary artery was affected. The isolated value of the magnitude of the inferior ST segment is not an efficient parameter for identifying the artery responsible for inferior AMI. In lead V2 all the patients with a lesion of the left circumflex artery showed ST segment depression > or = 1 mm (P < 0.001) and all those presenting ST segment elevation had stenosis of the proximal RCA. The most useful parameters for identifying the artery responsible for inferior AMI, with 100% specificity are: (1) for occlusion of the RCA, the arithmetic sum of ST segments: aVF + V2 > 0, with 86.9% sensitivity (P < 0.001); (2) for occlusion of the left circumflex artery III + V2 < 0, with 90% sensitivity (P < 0.001); and (3) for proximal occlusion of the RCA: aVF + V2 > or = 1, with 96.2% sensitivity (P < 0.001). No specific marker was observed for distal occlusion of the RCA. The value of the arithmetic sum of the ST segment: III + V2 between 0 and 0.9 was the most significant, with 94.7% sensitivity and 95.7% specificity (P < 0.001).
为了评估心电图变化在诊断下壁心肌梗死责任动脉中的作用，对下壁和V2导联ST段偏移及其使用算术和（II + V2、III + V2以及aVF + V2）的相关性进行了一项前瞻性研究。研究了一组66例下壁急性心肌梗死（AMI）患者。在胸痛发作后6小时内进行标准12导联心电图检查。在梗死发生后1至12周对每位患者进行冠状动脉造影。发现46例患者右冠状动脉（RCA）病变，其中27例为近端病变，19例为远端病变；20例患者左旋支冠状动脉受累。下壁ST段幅度的单独值不是识别下壁AMI责任动脉的有效参数。在V2导联，所有左旋支动脉病变患者均表现出ST段压低≥1mm（P < 0.001），所有ST段抬高患者均有近端RCA狭窄。识别下壁AMI责任动脉的最有用参数，特异性为100%的有：（1）对于RCA闭塞，ST段算术和：aVF + V2 > 0，敏感性为86.9%（P < 0.001）；（2）对于左旋支动脉闭塞，III + V2 < 0，敏感性为90%（P < 0.001）；（3）对于近端RCA闭塞：aVF + V2 ≥ 1，敏感性为96.2%（P < 0.001）。未观察到RCA远端闭塞的特异性标志物。ST段算术和：III + V2在0至0.9之间的值最具意义，敏感性为94.7%，特异性为95.7%（P < 0.001）。
