左主干闭塞所致急性心肌梗死的心电图特点Electrocardiographic characteristics in patients with acute myocardial infarction associated with left main artery obstruction
杨新春,徐立,王乐丰,崔亮,葛永贵,王红石,佟子川,邹阳春,李惟铭
摘要(Abstract)：
目的分析急性左主干(LM)闭塞的常规心电图(ECG)表现,总结其ECG特点。方法1999年1月至2004年8月,10例急性心肌梗死(AMI)患者经急诊冠状动脉造影证实为急性LM闭塞(LM组),回顾性分析其急诊ECG表现。并选取同时期30例经急诊造影证实为左前降支(LAD)近段闭塞的AMI患者(LAD组),比较两组造影前的急诊ECG表现,以求总结急性LM闭塞的常规ECG特点。结果LM组心率快于LAD组,在心律失常发生率方面两组差异无统计学意义。LM组中9例患者存在aVR导联ST段抬高(≥0·05mV),发生率明显高于LAD组(分别为90%和36·7%,P=0·002),同时LM组aVR导联ST段抬高幅度亦明显大于LAD组。而LM组胸前导联V1-3的ST段抬高程度则明显低于LAD组。aVR导联ST段抬高>0·05mV诊断急性LM闭塞的敏感性为90%,特异性为63·3%。如果同时再满足V1+V2+V3导联ST段抬高程度<0·5mV,其诊断急性LM闭塞的敏感性为90%,特异性达到86·7%。结论aVR导联ST段抬高>0·05mV,同时伴有V1~V3导联ST段抬高不明显、甚至压低是急性LM闭塞区别于LAD闭塞的ECG特点,结合临床表现,分析ECG特点可能有助于造影术前预测此类患者和风险评价。
关键词(KeyWords)： 心肌梗死;冠状血管;心电描记术
基金项目(Foundation):
作者(Author): 杨新春,徐立,王乐丰,崔亮,葛永贵,王红石,佟子川,邹阳春,李惟铭
参考文献(References)：
- [1]Yamajj H,Iwasaki K,Kusachi S,et al.Predictionof acuteleft main coronary artery obstruction by12-lead.Electrocardiography.J Am Coll Cardiol,2001,38:1348-1354.
- [2]Iwasaki K,Kusachi S,Hina K,et al.Acute left main coronary artery obstruction with myocardial infarction.Jpn Circ J,1993,57:891-897.
- [3]Marso SP,Steg G,Plokker T,et al.Catheter-based reperfusion of unprotectedleft main stenosis during an acute myocardial infarction(the ULTIMAexperience).Unprotected Left Main TrunkIntervention Multi-center Assessment.AmJ Cardiol,1999,83:1513-1517.
- [4]Lee SW,Hong MK,Lee CW,et al.Early andlate clinical outcomes after primary stenting of the unprotected left main coronary artery stenosis in the setting of acute myocardial infarction.Int J Cardiol,2004,97:73-76.
- [5]Kurisu S,Inoue I,Kawagone T,et al.Electrocardiographic features in patients with acute myocardial infarction associated with left main artery obstruction.Heart,2004,90:1059-1060.
- [6]Engelen DJ,Gorgels AP,Cheriex EC,et al.Value of the Electrocardiogramin localizing the occlusion site in the left anterior descending coronary artery in acute anterior myocardial infarction.J AmColl Cardiol,1999,34:389-395.