Prective value of electrocardiogram in localizing the occlusion site in the left anterior descending coronary artery in acute anterior myocardial infarction / 中国介入心脏病学杂志

ABSTRACT

Objective To evaluate the predictive value of electrocardiogram in localizing the occlusion site in the left anterior descending coronary artery(LAD) in acute anterior myocardial infarction(AMI).Methods According to the coronary angiogram,all patients with AMI were divided into two groupsone(the PS group) was a collection of patients(n=61) whose occlusion sites were proximal to the first septal branch(S1) and the other(the DS group) was a collection of patients(n=40) whose occlusion site were distal to S1.Diagnostic sensitivity and specificity in prediction of the occlusion site in LAD were calculated based on the measurements and incidence of ST segments deviation on electrocardiogram(ECG).Results The sensitivity and specificity for prediction of occlusion site being proximal to S1 in LAD using ECG were as follow43% and 85%(P=0.004) for ST elevation in lead aVR,16% and 97%(P=0.031) for ST elevation≥1.5 mm in lead aVL,39% and 85%(P=0.009) for ST depression≥1.0 mm in lead Ⅱ,23% and 98%(P=0.005)for ST depression ≥2.0 mm in lead Ⅲ,38% and 88%(P=0.006) for ST depression ≥1.0 mm in lead aVF,20% and 86%(P=0.037) for ST depression in lead V5,18% and 100%(P=0.005) for ST elevation in lead aVR together with ST depression in leads V5,30% and 93%(P=0.008) for ST elevation in lead aVR together with ST depression in leads V6.The sensitivity and specificity for diagnosis of occlusion site being distal to S1 were 53% and 90%(P=0.000)ST elevation or unchanged in lead Ⅲ,50% and 82%(P=0.001) for ST elevation in lead V5.There were no significant difference in infarction size and left ventricle ejection fraction between the two groups.Conclusion(1) ST elevation in lead aVR together with ST depression in leads V5 and V6,obvious ST depression in the inferior leads,and ST elevation in leads I and aVL were all indication of occlusion in LAD proximal to S1.(2) ST elevation or unchanged in inferior leads(especially in lead Ⅲ),and marked ST elevation in lead V5 indicated that the occlusion site in LAD was distal to S1.