Kosuge M, Kimura K, Ishikawa T, Hongo Y, Mochida Y, Sugiyama M, Tochikubo O
Critical Care and Emergency Medical Center, and the Second Department of Internal Medicine, Yokohama City University School of Medicine, Yokohama, Japan.
Am J Cardiol. 1998 Dec 1;82(11):1318-22. doi: 10.1016/s0002-9149(98)00634-1.
In patients with inferior wall acute myocardial infarction (AMI), the site of the culprit lesion is an important determinant of outcome. Patients with right ventricular infarction have a poor prognosis, whereas those with occlusion of the left circumflex coronary artery (LCx) have a good prognosis. Therefore, we assessed whether standard 12-lead electrocardiograms obtained on admission could identify the site of coronary artery occlusion, (i.e., a site proximal to the origin of the right ventricular branch of the right coronary artery [RCA], a site distal to the origin of the right ventricular branch of the RCA, or a site in the LCx). The ratio of ST depression in lead V3 to ST elevation in lead III (V3/III ratio) was evaluated immediately before coronary angiography in 152 patients with a first inferior wall AMI confirmed by coronary angiography within 12 hours after the onset of symptoms. For occlusion of the proximal RCA, distal RCA, and LCx, V3/III ratio was 0.2+/-0.3, 0.8+/-0.5, and 2.5+/-2.5 (p = 0.0001), respectively. The V3/III ratio <0.5 identified proximal RCA occlusion, 0.5 <V3/III ratio < or = 1.2 identified distal RCA occlusion, and 1.2 <V3/III ratio identified LCx occlusion with sensitivities of 91%, 84%, and 84%, and specificities of 91%, 93%, and 95%, respectively. We conclude that the V3/III ratio is useful in predicting the site of coronary artery occlusion in patients with inferior wall AMI.
在下壁急性心肌梗死（AMI）患者中，罪犯病变部位是预后的重要决定因素。右心室梗死患者预后较差，而左旋支冠状动脉（LCx）闭塞患者预后良好。因此，我们评估了入院时获得的标准12导联心电图是否能够识别冠状动脉闭塞部位（即右冠状动脉[RCA]右心室分支起始部近端、RCA右心室分支起始部远端或LCx中的部位）。在症状发作后12小时内通过冠状动脉造影确诊为首次下壁AMI的152例患者中，在冠状动脉造影前即刻评估V3导联ST段压低与III导联ST段抬高的比值（V3/III比值）。对于RCA近端闭塞、RCA远端闭塞和LCx闭塞，V3/III比值分别为0.2±0.3、0.8±0.5和2.5±2.5（p = 0.0001）。V3/III比值<0.5识别RCA近端闭塞，0.5<V3/III比值≤1.2识别RCA远端闭塞，1.2<V3/III比值识别LCx闭塞，敏感性分别为91%、84%和84%，特异性分别为91%、93%和95%。我们得出结论，V3/III比值有助于预测下壁AMI患者的冠状动脉闭塞部位。
