ST段抬高急性心肌梗死患者心电图对应导联ST段改变不同类型的临床预后

目的探讨ST段抬高急性心肌梗死（STEMI）患者心电图（ECG）对应导联ST段改变（R-ST-D）不同类型与罪犯冠状动脉病变及临床预后的关系。方法选择住院初发STEMI资料完整967例，根据R-ST-D振幅分4种类型，即R-ST-D振幅无下移（I组）143例；R-ST-D下移振幅小于或等于梗死区ST段抬高振幅（1I组）664例；R-ST-D下移振幅大于梗死区ST段抬高振幅（Ⅲ组）93例；R-ST-D和梗死区ST段均抬高（IV组）67例；分析其ECGR-ST-D4种类型与罪犯冠状动脉病变和临床高危预后的关系。结果R-ST-D4种类型中I组、Ⅱ组、Ⅲ组发生率分别为14．8％，68．7％，9．6％，并以前降支为主单支病变多见。Ⅳ组发生率6．9％，主要累及复合前壁，前降支，回旋支及右冠状动脉。泵衰竭、低血压、严重心律失常、AMI扩展、室壁运动失调、左室射血分数≤50％及住院病死率分别为71．6％，41．8％，61．2％，34．3％，100．0％，40．3％和16．4％（P〈0．05或P〈0．01）。结论STEMI患者ECGR．ST-D不同类型对罪犯冠状动脉病变和临床近期预后具有预测作用。

Clinical prognosis of patients with acute ST segment elevation myocardial infarction predicted by different electrocardiogram ST segment depression types

Objective To explore the relationship of culprit artery lesion and clinical prognosis with different electrocardiogram（ECG） reciprocal ST segment depression（R-ST-D） types in patients with acute ST segment elevation myocardial infarction（STEMI）. Methods Totally 967 cases of STEMI with completed data were enrolled in present study. The patients were then divided into four groups according to the amplitude of R-ST-D. Group I consisted of 143 patients with non R-ST-D; group II consisted of 664 patients whose amplitude of R-ST-D were less or equal to the amplitude of the ST segment elevation in myocardial infarction area; group III consisted of 93 patients whose amplitude of R-ST-D was larger than the amplitude of the ST segment elevation; group 1V consisted of 67 patients whose corresponding ST segment and ST segment in myocardial infarction area were all elevated. The culprit artery lesion and clinical prognosis were compared between the four groups. Results The occurrence of R-ST-D were recorded, which were 14.8%, 68.7%, and 9.6% in group I, II, and III, respectively, which mainly involved anterior descending branch. In group IV, the incidence was 6.9%, and it mainly involved complex anterior wall, anterior descending branch, circumflex branch, and right coronary artery. The prognosis indices included pump failure, low blood pressure, malignant arrhythmia, infarction extension, ventricular wall incoordination, left ventricular ejection fraction≤ 50%, and in-hospital mortality, which were 71.6%, 41.8%, 61.2%, 34.3%, 100.0%, 40.3%, and 16.4% respectively（P 〈 0.05 or P 〈 0.01）. Conclusion Different ECG R-ST-D in patients with acute ST segment elevation myocardial infarction can forecast the culprit artery lesion and clinical prognosis.