EKG Criteria Predict Infarct-related Artery of Inferior Wall AMI

從心電圖預測引發急性下壁心肌梗塞之冠狀動脈

蔣俊彥(Chun-Yen Chiang) ； 顧博明(Po-Ming Ku) ； 黃崔源(Tsuei-Yuan Huang) ； 鄭成泉(Chen-Chuan Cheng) ； 吳文憲(Wen-Shiann Wu) ； 陳志成(Zhih-Cherng Chen)周銘霆(Ming-Ting Chou)

《Acta Cardiologica Sinica》 22卷2期 (2006/06) Pp. 67-74

摘要

背景　我們嘗試利用十二導程心電圖及右胸心電圖ST區段的變化來推測造成急性下壁心肌梗塞是那一條冠狀動脈。
方法及結果　我們從1999年1月至2002年12月總共有528位病人發生急性心肌梗塞中，排除了病人曾經發生過心肌梗塞或有束支傳導阻斷，共有四十位病人符合急性下壁心肌梗塞，並根據冠狀動脈血管攝影分成右冠狀動脈或左迴旋冠狀動脈兩組。造成急性心肌梗塞冠狀動脈(IRA)定義為冠狀動脈血管攝影下其冠狀動脈所供應的心肌醫生收縮失調且其冠狀動脈為完全堵塞或不完全堵塞或者是其冠狀動脈內有血栓及超過百分之五十的動脈狹窄。比較十項不同心電圖判讀標準用來預測引發急性下壁心肌梗塞相關之冠狀動脈，並比較其敏感度及特異度。我們獲得兩項有用的心電圖判別標準預測引發急性下壁心肌梗塞相關之冠狀動脈，一項是心電圖肢導程Ⅰ在ST區段為等電位線或ST區段上升來推測IRA為左迴旋冠狀動脈，其敏感度為63%，特異度為87.5%。另一項是心電圖肢導程AVL在ST區段下降大於肢導程Ⅰ合併肢導程Ⅲ在ST區段上升大於肢導程Ⅱ來推測IRA為右冠狀動脈其敏感度為97%，特異度為50%。
結論　心電圖肢導程Ⅰ在ST區段為等電位線或ST區段上升來推測IRA為左迴旋冠狀動脈及肢導程AVL在ST區段下降大於肢導程Ⅰ合併肢導程Ⅲ在ST區段上升大於肢導程Ⅱ來推測IRA為右冠狀動脈是兩項有用的預測引發急性下壁心肌梗塞相關之冠狀動脈之心電圖判別標準。

關鍵字

心電圖 ； 心肌梗塞相關之冠狀動脈 ； 急性心肌梗塞 ； 冠狀動脈血管攝影

並列摘要

Background: We attempted to predict the infarct-related artery (IRA) of inferior wall acute myocardial infarction (AMI) by assessing the relative ST-segment deviation on surface electrocardiogram (EKG).
Methods and Results: We evaluated 12-lead and right-sided EKG with ST-segment elevation-type inferior wall AMI from 528 consecutive patients with AMI in Chi-Mei Foundation Hospital between 1999 and 2002. Patients with previous myocardial infarction or bundle branch block were excluded. Forty cases were enrolled in the study and were divided into two groups according to the IRA, either right coronary artery (RCA) or left circumflex artery (LCX). IRA was determined by the angiographic criteria: the artery supplying the area of asynergy with (1) total or subtotal occlusion, or (2) arteriographic features suggestive of thrombus in arteries with more than 50% luminal stenosis. Ten EKG criteria were used for comparison. There were two useful EKG criteria for predicting the IRA. Isoelectric or elevated ST-segment in lead Ⅰ could predict LCX as the IRA with 87.5% specificity and 63% sensitivity. Greater ST depression in lead aVL than in lead Ⅰ and greater ST elevation in lead Ⅲ than in lead Ⅱ could predict RCA as the IRA with 50% specificity and 97% sensitivity.
Conclusion: Isoelectric or elevated ST-segment in lead Ⅰ suggesting LCX as the IRA and greater ST depression in lead aVL than in lead Ⅰ and greater ST elevation in lead Ⅲ than in lead Ⅱ suggesting RCA as the IRA are two useful EKG criteria for identification of IRA of inferior wall AMI.

並列關鍵字

Electrocardiogram ； Infarct-related artery ； Acute myocardial infarction ； Coronary artery disease ； Coronary angiography