急性前壁心肌梗死患者心电图表现与冠脉造影对比研究

目的分析急性前壁心肌梗死的梗死相关血管特点和心电图分布特征,为临床判断冠状动脉病变部位提供线索。方法经冠状动脉造影证实为单支血管病变的142例初发急性前壁心肌梗死患者,根据心电图表现分为四组。比较各组间梗死相关动脉的病变特点。结果单纯前壁心肌梗死的犯罪血管病变82%(3644)在前降支中段,前壁心肌梗死合并下壁导联ST段压低的犯罪血管病变80%(2430)在前降支近段,前壁心肌梗死合并下壁导联ST段抬高者,犯罪病变54%(2037)在右冠状动脉,46%(1737)在左前降支,广泛前壁心肌梗死的犯罪病变主要在前降支近段85%(2327),P<0.001;前壁心肌梗死是否合并下壁导联ST段偏移,其血管病变程度与侧支循环建立相近,均好于广泛前壁心肌梗死患者。结论根据心肌梗死时心电图异常的分布特点,可以推测急性前壁心肌梗死病变的部位,良好的侧支循环有助于限制梗死面积。

Comparative observation between electrocardiogram manifestations and coronary artery angiography in patients with acute anterior wall myocardial infarction

Objective To study the characteristics of angiography and electrocardiogram in acute anterior wall myocardial infarction,and give clinical clue for deducing the location of coronary artery lesions. Methods One hundred and forty-two patients with acute anterior wall myocardial infarction for the first time and confirmed to have single vessel coronary artery disease by angiography,were divided into 4 groups according to the electrocardiogram (ECG) changes at onset of infarction:(1) Group A was single acute anterior wall myocardial infarction (46 cases).(2)Group B was anterior wall myocardial infarction with inferior wall ST elevation (37 cases).(3) Group C was anterior wall myocardial infarction with inferior wall ST depression (31 cases).(4)Group D was extensive anterior wall myocardial infarction (28 cases). Results The infarction related lesion were mainly on middle left anterior descending (LAD) arteries in group A (82%,36/44),The infarction related lesion were mainly on proximal LAD in group C (80%,24/30) and group D (85%,23/27). In contrast,group B had two distinct subsets of patients with either right coronary artery(54%,20/37),or LAD (46%,17/37),P<0.001. The occlusive lesion and collaterals were similar among the patients with anterior wall infarction or plus inferior wall ST change,were worse in the patients with extensive anterior infarction. Conclusion The location of infarction-related lesions can be deduced from the ECG change at the onset of anterior wall infarction,and infarction area can be limited by better collaterals.