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目的将体表心电图(ECG)预测的梗死相关动脉(IRA)与冠状动脉造影结果进行对比分析,以了解判断错误的原因。方法搜集2006年10月至2011年10月就诊的急性ST段抬高心肌梗死(STEMI)患者,发病时间≤12 h并且术前有≥2份18导联ECG,排除既往有陈旧性心肌梗死、冠状动脉旁路移植术后、起搏器置入术后或ECG显示有左束支传导阻滞的患者。所有患者入院后都在2 h内施行了急诊冠状动脉造影。采用最常用的ECG标准判断IRA,并与冠状动脉造影结果进行对比分析。结果入选STEMI患者256例,其中214例能够通过ECG判断IRA,24例判断错误,18例无法判断。判断错误和无法判断的42例患者中有19例(45.2%)IRA为左回旋支,16例(38.1%)为右冠状动脉,5例(11.9%)为左前降支,1例(2.4%)为中间支,l例(2.4%)为左主干;7例(16.7%)合并双支病变,7例(16.7%)合并三支病变;2例(4.7%)合并早期复极综合征;2例(4.7%)患者冠状动脉造影提示小分支闭塞。结论侧支循环影响ECG对IRA的判断。ECG无法判断IRA时最常见于左回旋支、右冠脉病变。解剖变异、早期复极综合征或小分支闭塞也会影响IRA的判断。
Objective To compare and analyze the infarction related artery (IRA) predicted by the body surface electrocardiogram (ECG) and the results of coronary angiography to understand the reason of the error. Methods Acute ST-segment elevation myocardial infarction (STEMI) patients from October 2006 to October 2011 were enrolled in the study. The onset time was ≤12 h and ≥2 18-lead ECGs were preoperatively diagnosed. All patients with previous myocardial infarction, After coronary artery bypass grafting, patients with left bundle branch block after ECG or pacemaker implantation are indicated. All patients underwent emergency coronary angiography within 2 h after admission. The most commonly used ECG criteria to judge the IRA and coronary angiography results were compared. Results A total of 256 STEMI patients were enrolled. Among them, 214 were able to determine IRA by ECG, 24 were wrongly diagnosed, and 18 were unidentifiable. Nineteen (45.2%) of the 42 patients with incorrect and unidentifiable judgments had left circumflex artery IRA, 16 (38.1%) had right coronary artery, 5 (11.9%) had left anterior descending artery and 1 (2.4% ) Were the middle branch, 1 case (2.4%) was the left main trunk, 7 cases (16.7%) had double-vessel disease, 7 cases (16.7%) had 3 lesions, 2 cases (4.7% Coronary angiography in 2 patients (4.7%) showed small branch occlusion. Conclusion The collateral circulation influences the judgment of ECG by IRA. ECG can not determine the IRA is most common in the left circumflex branch, right coronary artery lesions. Anatomic variations, early repolarization syndrome or small branch occlusion can also affect the IRA’s judgment.