Analysis of the relationship between electrocardiographic ST segment diversify and infarction of related artery and the site of occlusion in acute inferior myocardial infarction / 中国医师进修杂志

ABSTRACT

Objective To predict the infarction of related artery(IRA)and the site of occlusion by analyzing the diversify of electrocardiographic ST segment and coronary angiography findings in acute inferior myocardial infarction. Methods Sixty-four patients with acute inferior myocardial infarction were divided into two groups by coronary angiography right coronary artery(RCA)occlusion group(51 patients)and left circumflex coronary artery(LCX)occlusion group(13 patients). RCA occlusion group included proximal,middle and distal components occlusion, and LCX occlusion group included proximal and distal components occlusion. The cases of STⅢ elevation ＞ ST Ⅱ ,STaVL depression ＞ STⅠ ,STV1 depression,STV7-V9 and STV3R-V5R elevation were recorded and compared. Results The percentage of STⅢ elevation ＞ STⅡ, STaVL depression ＞STⅠ, STV1 no depression, STV7-V9 no elevation and STV3R-V5R elevation was significantly higher in RCA occlusion group than those in LCX occlusion group(P ＜ 0.01 or ＜ 0.05). The percentage of ST Ⅲ elevation ≤ ST Ⅱ, ST,VL depression ≤STⅠ ,STV1 depression,STV7-V9 elevation,STV3R-V5R no elevation was significantly higher in LCX occlusion group than those in RCA occlusion group(P ＜0.01 or ＜0.05). In RCA occlusion groupthe sensitivity of STⅢ elevation ＞ STⅡ, STaVL depression ＞ STⅠ and STV1 no depression was 90.2%, 80.4% and 80.4%;the specificity of STⅢ elevation ＞ STⅢ and STaVL depression ＞ STⅠwas 84.6% and 84.6% ;the sensitivity of STV3R-V5R elevation was 51.0%, but its specificity was 100.0%. In LCX occlusion group the sensitivity of STⅢ elevation ≤ ST Ⅲ and STaVL depression ≤ ST Ⅰ was 84.6% and 84.6%, and their specificity was 90.2% and 80.4%;the specificity of STV1 depression and STV7-V9 elevation was 80.4% and 78.4%; the sensitivity of STV3R-V5R no elevation was 100.0% ,and its specificity was 51.0%. In RCA occlusion group, the percentage of STV3R-V5Relevation was higher in proximal components occlusion than that in distal components occlusion[76.9%(10/13)vs. 27.3%(3/11),P=0.015]. Conclusions The IRA can be initially judged by analysis of the characteristics in the ST segment in Ⅰ,Ⅱ ,Ⅲ ,aVL,V1,V7-V9,V3R-V5R lead in acute inferior myocardial infarction. And the ST segment elevation in V3R-V5R is meaningful in the judgment of proximal and distal components occlusion in RCA.