RESUMEN
Objective To study the relationship between ECG ischemic grading and target vessel stenosis degree in patients with acute myocardial infarction ( AMI ) . Methods A total of eighty patients with AMI treated in Beijing Friendship Hospital, Capital Medical University from January 2016 to June 2017 were enrolled in the study, with the onset time<12 h, According to the Birnbaum ECG grading, the patients were divided into the grade two ischemic group( 50 cases) and grade three ischemic group( 30 cases) . CAG diameter visual method was used to compare the target vessels localization and stenosis degrees,the levels of CK?MB,cTnI and pro?BNP,left ventricular end diastolic diameter ( LVEDd) and ejection fraction ( LVEF) were detected, myocardial infarction area ( MIS) was measured by 99mTe?MIBI myocardial perfusion imaging ( SPECT) at 7 d after operation,the incidence of major cardiac adverse events ( MACE) was followed up for 6 months. area of myocardial defect,that is myocardial infarction size(MIS)with SPECT 7d after operation,during the 6 months follow?up,the incidence of major adverse cardiac events ( MACE) . Results The baseline lines of CK?MB,cTnI and pro?BNP and increased ranges ( post intervention?baseline value) in the grade three ischemic group were higher than those of grade two ischemia group,there were statistically significant differences in baseline values:(CK?MB:(56. 7±12. 3) U/L vs. (26. 8±8. 7) U/L,t=12. 326,P<0. 001; increase: (66. 7±13. 5) U/L vs.(35. 6)±6. 9) U/L,t=32. 545,P<0. 001; cTnI: baseline value: (8. 6±2. 2) g/L vs. (4. 5±1. 3) g/L,t=6. 598,P=0. 003;increase:(15. 2±5. 7) g/L vs. (6. 3±2. 5) g/L,t=9. 524,P<0. 001; pro?BNP: baseline value:(356. 7±65. 8) mol/L vs. (254. 5±56. 7) mol/L,t=10. 326,P<0. 001; increase: (658. 4±135. 2) mol/L vs. (356. 2±95. 4) mol/L,t=25. 254,P<0. 001). There was no significant difference in LVEDd and LVEF between groups. (LVEDd:(55. 2±2. 6) mm vs. (54. 8±2. 3) mm,t=0. 263,P=0. 785; LVEF: (42. 5 ±4. 8)％ vs. (43. 3±4. 5)％,t=0. 426,P=0. 659). The occurrence rates of left anterior descending,left main lesions and left main bifurcation lesions in the grade three ischemic group were higher ( 50. 0％ vs. 10. 0％,χ2=16. 000,P<0. 001;16. 7％ vs. 4. 0％,χ2=2. 348,P=0. 125;10. 0％ vs. 4. 0％,χ2=0. 356,P=0. 551),and the circumflex and right coronal and branch lesions proportions took the most part in the grade two ischemic group(10. 0％ vs. 30. 0％,χ2=4. 301,P=0. 038;10. 0％ vs. 40. 0％,χ2=8. 238,P=0. 004;3. 3％ vs. 12. 0％,χ2=0. 845,P=0. 358);the proportions of target lesion number>1 and 100％ stenosis in the grade three ischemic group were significantly than those in the in the grade two ischemic group ( target lesion number>1:36. 7％ ( 11/30) vs. 14％ (7/50),P=0. 019;100％ stenosis:40％ (12/30) vs. 12％ (6/50),P=0. 004),the difference is statistically significant. The MIS value increased significantly in the grade three ischemia group, and the incidence of MACE increased. The difference was statistically significant ( (16. 7±3. 5)％ vs. (10. 5±3. 6)％,t=5. 754,P=0. 019,23. 3％ vs. 6％,χ2=5. 150,P=0. 023) . Conclusion ECG ischemic grading can evaluate the location of AMI target vessel and the degree of stenosis,and it has important clinical value.