Tamura A, Kataoka H, Mikuriya Y, Nasu M
Second Department of Internal Medicine, Oita Medical University, Japan.
Eur Heart J. 1995 Dec;16(12):1795-9. doi: 10.1093/oxfordjournals.eurheartj.a060830.
To determine whether or not ST segment deviation on admission electrocardiograms can identify patients with anterior acute myocardial infarction due to proximal left anterior descending artery occlusion, the magnitude and location of ST segment elevation or depression were compared between patients with proximal left anterior descending artery occlusion (group A, n = 47) and those with distal left anterior descending artery occlusion (group B, n = 59). ST segment depression in each of the inferior leads was significantly greater in group A than in group B. The incidence of ST segment depression > or = 1 mm in each of the inferior leads (II; 81% vs 27%, III; 85% vs 54%, aVF; 87% vs 47%, P < 0.01) was significantly higher in group A than in group B. In addition, the incidence of ST segment depression > or = 1 mm in all of the inferior leads was significantly greater in group A than in group B (77% vs 22%, P < 0.01). In group A, maximal ST segment elevation was more frequent in lead V2 alone (43% vs 14%, P < 0.01). Group A had greater ST segment elevation in lead aVL than group B, and the incidence of ST segment elevation > or = 1 mm in lead aVL was significantly higher in group A than in group B (66% vs 47%, P < 0.05). ST segment depression > or = 1 mm in all of the inferior leads was most valuable for identifying group A patients (77% sensitivity and 78% specificity). In contrast, the maximal ST segment elevation in lead V2 alone or ST segment elevation > or = 1 mm in lead aVL had a low diagnostic value (43% sensitivity and 86% specificity, 66% sensitivity and 53% specificity, respectively). In conclusion, this study indicates that analysis of ST segment deviation in the inferior leads is useful for identifying patients with acute anterior myocardial infarction due to proximal left anterior descending occlusion.
为了确定入院心电图上的ST段偏移能否识别出因左前降支近端闭塞所致的前壁急性心肌梗死患者，对左前降支近端闭塞患者（A组，n = 47）和左前降支远端闭塞患者（B组，n = 59）的ST段抬高或压低的幅度及部位进行了比较。A组各下壁导联的ST段压低明显大于B组。A组各下壁导联（II导联：81% 对27%，III导联：85% 对54%，aVF导联：87% 对47%，P < 0.01）ST段压低≥1 mm的发生率明显高于B组。此外，A组所有下壁导联ST段压低≥1 mm的发生率明显高于B组（77% 对22%，P < 0.01）。在A组，仅V2导联出现最大ST段抬高更为常见（43% 对14%，P < 0.01）。A组aVL导联的ST段抬高大于B组，且A组aVL导联ST段抬高≥1 mm的发生率明显高于B组（66% 对47%，P < 0.05）。所有下壁导联ST段压低≥1 mm对识别A组患者最具价值（敏感性77%，特异性78%）。相比之下，仅V2导联的最大ST段抬高或aVL导联ST段抬高≥1 mm的诊断价值较低（敏感性分别为43% 和66%，特异性分别为86% 和53%）。总之，本研究表明，分析下壁导联的ST段偏移有助于识别因左前降支近端闭塞所致的急性前壁心肌梗死患者。
