aVR ST段抬高对急性冠状动脉综合征患者罪犯病变的预测价值  

The Predictive Value of ST Segment Elevation in Lead aVR for Culprit Lesions in Acute Coronary Syndrome

作　　者：邵元霞[1] 车京津[1] 

机构地区：[1]天津医科大学心内科第二医院心脏科,300211

出　　处：《心电学杂志》2011年第6期449-451,共3页Journal of Electrocardiology(China)

摘　　要：目的 探讨aVR ST段抬高对非ST段抬高性急性冠状动脉综合征患者罪犯病变的预测价值.方法 选择因非ST段抬高性急性冠状动脉综合征入院的患者213例,根据aVR ST段分为抬高组和不抬高组,分析心电图与冠状动脉造影结果及冠状动脉病变范围及狭窄程度（以Gensini积分表示）的关系.结果 抬高组Gensini积分（58.16±43.85）高于不抬高组（23.53±26.80）,差异有统计学意义（P＜0.05）.而ST段抬高的3个亚组（抬高＜0.10mV、0.10～0.15mV、＞0.15mV）Gensini积分差异均无统计学意义（均P ＞0.05）.aVR ST段抬高0.5mV以上对左主干病变的敏感度、特异度、阳性预测值、阴性预测值分别为77.8%、59.5%、34.0%、90.9%;对三支病变分别为82.1%、67.1%、53.4%、89.1%;对左主干合并三支病变分别为88.5%、57.2%、22.3%、97.3%.结论 aVR ST段抬高者病变较重,但抬高幅度并不能预测狭窄程度.aVR ST段抬高是急性冠状动脉综合征左主干和（或）三支病变较强的预测因子.Objective To investigate the predictive value of ST segment elevation （STSE） in lead aVR for culprit lesions in patients with non-STSE acute coronary syndrome （ACS）. Methods 213 consecutive inpatients with non-STSE ACS were enrolled and divided into aVR＋ group （with STSE in lead aVR ） and aVR-group（without STSE in lead aVR）. The location and severity of coronary artery lesions were determined by coronary angiography. Gensini score was calculated. Results Gensini score was significantly higher in aVR＋ group than in aVR-group （P〈0.05）. There was no difference of Gensini score among subgroups of patients with STSE 〈0.1mV,0.1-0.15mV and 〉0.15mV. The sensitivity, specificity, positive predictive value and negative predictive value of STSE〉0.5mV in lead aVR were 77.8% ,59.5% ,34.0% and 90.9% for left main disease, 82. 1%, 67.1%, 53.4% and 89.1% for three-vessel coronary disease, 88.5%, 57.2%, 22.3% and 97.3% for left main disease combined with three-vessel coronary disease, respectively. Conclusion STSE in lead aVR may predict more severe coronary lesions such as left main and three-vessel diseases in ACS. There is no correlation between the magnitude of STSE in lead aVR and the degree of coronary stenosis.

关 键 词：急性非ST段抬高性冠状动脉综合征 心电图 冠状动脉造影术 GENSINI积分 

分 类 号：R541[医药卫生—心血管疾病]