心电图诊断冠脉前降支闭塞部位的研究  

A contrast study for electrocardiogram in anterior wall acute myocardial infarction in predicting of occlusion site in left anterior descending coronary artery angigraphy

作　　者：黄贵奇[1] 李德栋[1] 罗理宁 王俊谊[1] 颜程光[1] 

机构地区：[1]江西吉安井冈山大学附属医院,343000 [2]江西吉安吉安县中医院,343100

出　　处：《临床心电学杂志》2015年第1期19-22,共4页Journal of Clinical Electrocardiology

摘　　要：目的探讨前壁急性心肌梗死(AMI)体表心电图(ECG)预测前降支(LAD)阻塞部位的准确率。方法对2010年6月至2013年12月在井冈山大学附属医院心血管科145例前壁AMI患者ECG预测阻塞部位与冠状动脉造影术(CAG)显示阻塞部位进行对比分析。以大对角支(LD)或第一对角支(D1)为界划分LAD为近远段。结果前间壁AMI 20例,LAD阻塞部位均在LD或D1开口以远。前壁AMI、前壁+下壁AMI共67例LAD阻塞部位大多在LD或D1开口以远(80.6%vs.86.6%),两种分界法差异无统计学意义(p=0.351)。广泛前壁、广泛前壁+高侧壁、前壁+高侧壁AMI共58例LAD阻塞部位多发生LD或D1开口以近(96.55%vs.72.4%),两种分界法差异有显著的统计学意义(p=0.000),以LD为界有较高的阳性预测值(96.55%vs.72.41%p=0.000)、特异度(97.3%vs.83%,p=0.003),心电图判断LAD近段阻塞以LD分界更准确。结论前壁AMI心电图对预测LAD阻塞部位有较高的准确率。Objective To Explore the accuracy for electrocardiogram prediction of left anterior descending artery occlusion site in the anterior wall acute myocardial infarction. Methods The study included 145 anterior wall AMI patients＇ ECG predicted the occlusion sites were compared with CAG showed in the cardiovascular Department of Jinggangshan University Affiliated Hospital between Jun. 2010 and Dec. 2013. The Left anterior descending Artery was divided into proximal and distal segment by the large diagonal（LD） or the first diagonal（D1）.Results The location ofthe LAD occlusion occurred at distal to origin of D1 or LD in the patiens with anteroseptal AMI.The location of the LAD occlusion in total of 67 anterior wall AMI and anterior wall plus inferior wall AMI patiens mostly occurred at distal to origin of the D1 or the LD（80.6% vs. 86.6%）, no statistically significant difference between the two kinds of boundary method（p=0.351）.Extensiveanterior wall, extensiveanterior wall plus highlateral wall and anterior wall plus highlateral wall AMI total of 58 patients with LAD occlusion site occurred at LD or D1 opening proximal（96.55% vs. 72.4%）, and there were significant differences between the two boundary method（p=0.000）, a high positive predictive value（96.55% vs. 72.41% p=0.000）, specificity（97.3% vs. 83%, p=0.003）By LD, to judge LAD proximal occlusion was more accurately. Conclusions Anteriorwall AMI ECG occlusion site had higher accuracy of prediction LAD.

关 键 词：前降支 前壁急性心肌梗死 心电图 冠状动脉造影术 

分 类 号：R542.22[医药卫生—心血管疾病]