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心电图 Ⅱ,Ⅲ导联ST段抬高比值在判定下壁心肌梗死病变血管中的作用(PDF)

《心脏杂志》[ISSN:1009-7236/CN:61-1268/R]

期数:
2002年第4期
页码:
329-330, 333
栏目:
临床研究
出版日期:
2002-07-01

文章信息/Info

Title:
Usefulness of ST elevationⅡ/Ⅲratio for identifying the culprit artery in inferior wall acute myocardial infarction
作者:
王兴元张 清贾国良张文君王海昌张殿新李成祥何 争吕安林
第四军医大学西京医院心血管内科,陕西西安710032
Author(s):
WANG Xing-yuanZHANG QingJIA Guo-liangZHANG Wen-junWANG Hai-changZHANG Dian-xinLI Cheng-xiangHE ZhengLU。An-lin
Departmet of Cardiology,Xijing Hospital,Fourth Military Medical University,Xi′an,Shaanxi710032,China
关键词:
心肌梗塞急性心电描记术ST段
Keywords:
myocardial infarctionacuteelectrocardiographyratio of ST elevation
分类号:
R540.41
DOI:
-
文献标识码:
A
摘要:
目的 通过心电图早期识别下壁心肌梗死的病变血管是右冠状动脉(RCA)还是左回旋支(LCCA),为临床处理和预防并发症提供帮助。方法 对273例下壁心肌梗死患者的心电图Ⅱ,Ⅲ导联ST段比值(STⅡ/Ⅲ)和冠脉造影结果进行分析。结果 STⅡ/Ⅲ=1检测LCCA的特异度、敏感度、阳性预测值和阴性预测值分别为81%,97%,86%和96%;STⅡ/Ⅲ<1对检测RCA的敏感度、特异度、阳性预测值和阴性预测值分别为97%,91%,98%和89%;而STⅠ→检测LCCA的敏感度、特异度、阳性预测值和阴性预测值分别为75%,96%,82%和94%;STⅠ↓检测RCA的敏 感度、特异度、阳性预测值和阴性预测值分别为96%,81%,96%和84%。结论 这4种新方法对判断下壁心肌梗死相关血管的敏感度和特异度均较高,且简便实用。
Abstract:
AIM To recognize early whether the culprit artery is the right coronary artery (RCA) or left circumflex coronary artery(LCCA), so as to facilitate the management and, in some instances,the prevention of complications.METHODS We studied 273 consecutive patients with acute inferior wall myocardial infarctions who subsequently underwent coronary angiography. The principal investigator analyzed all the admission 12-lead electrocardiograms.RESULTS We found that STⅡ/Ⅲ=1 had a specificity of 81%,sensitivity of 97%,positive predictive value of 86%,negative predictive value of 96% for LCCA,whereas an isoelectric ST(STⅠ→) in leadⅠ had a specificity of 75%,sensitivity of 96%,positive predictive value of 82%,negative predictive value of 94% for LCCA. The criterion STⅡ/Ⅲ<1 had a sensitivity of 97%,specificity of 91%, positive predictive value of 98%,and negative predictive value of 89% for RCA,whereas ST depression (STⅠ↓) in leadⅠhad a sensitivity of 96%,specificity of 81%,positive predictive value of 96%,and negative predictive value of 84% for RCA.CONCLUSION These 4 criteria are useful in the recognition of infarction-related artery in inferior wall acute myocardial infarction, and more sensitive and specific than previously reported methods.

参考文献/References

[1] Assali AR,Herz I,Vaturi M,et al. Electrocardiographic criteria for predicting the culprit artery in inferior wall acute myocardial infarction[J].Am J Cardiol,1999,84:87-88.

[2] O′Keefe JH,Sayed-Taha,K,Gibson W,et al. Do patients with left circumflex coronary artery-related acute myocardial infarction without ST-segment elevation benefit from reperfusion therapy? [J].Am J Cardiol,1995,75:718-720.

[3] Hertz I,Assali AR,Adler Y,et al. New electrocardiographic criteria for predicting either the right or left circumflex artery as the culprit coronary artery in inferior wall acute myocardial infarction[J].Am J Cardiol,1997,80:1343-1345.

[4] Moskovits N, Khan M, Budzilowicz L,et al. STⅡ/Ⅲ: a new electrocardiographic criteria for the identifcation of the culprit vessel in inferior wall acute myocardial infarction(abstr)[J].J Am Coll Cardiol,1997,29(Suppl A):430A.

[ 5] Kontos CM, Desai VP, Jesse LP,et al. Usefulness of the admission electrocardiogram for identifying the infarct-related artery in inferior wall acute myocardial infarction[J].Am J Cardiol,1997,79:182-184.

[ 6 ] Bairey CN, Shah PK, Lew AS. Electrocardiographic differentiation of occlusion of the left circumflex versus the right coronary artery as a cause of inferior acute myocardial infarction [J].Am J Cardiol,1987,60:456-459.

[7] Wong CK,Freedman SB. Electrocardiographic identification of the infarct-related artery in acute inferior myocardial infarction [J].Int J Cardiol,1996,54:5-11.

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备注/Memo

备注/Memo:
收稿日期:2001-07-10.
更新日期/Last Update: 2002-07-01