以新的心電圖診斷要點來判定急性下壁心肌梗塞的病灶部位

New Electrocardiographic Criteria for Identification the Culprit Site of Coronary Artery in Inferior Wall Acute Myocardial Infarction

周立平(Li-Ping Chou)

指導教授 ： 譚秀芬

長榮大學/健康科學學院/醫務管理學研究所/碩士(2007年)

https://doi.org/10.6833/CJCU.2007.00043

摘要

背景：急性下壁心肌梗塞的病灶血管會影響臨床癒後，包括右冠狀動脈近端及遠端和左迴旋動脈三處。數篇發表的文章以不同的心電圖診斷要點來區分右冠狀動脈或左迴旋動脈，但是只有一篇文章是以心電圖的V3/Ⅲ比值來預估三處可能引發心肌梗塞的血管，更具有廣泛的臨床運用價值，可惜病人有選擇性。本研究是利用新的心電圖診斷要點來判定可能引發急性下壁心肌梗塞的可能三處冠狀動脈。
方法及結果：71位急性下壁心肌梗塞的病人，沒有心肌梗塞病史，心電圖沒有束枝傳導阻塞，且第一張心電圖是在胸痛發病的12小時內取得的病人，被選入在本研究。這些病人病灶根據冠狀動脈攝影被分為三群，右冠狀動脈的右心室枝之前（近端）、後（遠端）及左迴旋動脈。第一張心電圖上的導程Ⅲ除以Ⅱ的值當作預測指標。近側右冠狀動脈，遠側右冠狀動脈及迴旋動脈之Ⅲ/Ⅱ比值分別為2.1 ± 0.7，1.6 ± 0.6，1.0 ± 0.2（P ＜ 0.0001）。依據receiver operating characteristic座標值選定Ⅲ/Ⅱ比值大於等於1.8判定為近側右冠狀動脈病灶；小於1.8且大於等於1.2判定為遠側冠狀動脈；小於1.2判定為左迴旋動脈。如此預測之敏感性分別為73%，76%，75%，專一性為88%，79%，92%。
結論：導程Ⅲ/Ⅱ比值的心電圖診斷要點，可以提供簡單、又有用的方法，來判定急性下壁心肌梗塞的病灶血管部位。

關鍵字

心電圖 ； 急性心肌梗塞 ； 冠狀動脈攝影

並列摘要

Background: The culprit coronary artery in inferior wall acute myocardial infarction (AMI) is one of the major factors of determining the clinical outcome. Several electrocardiographic criteria have been proposed to differentiate between the right coronary artery (RCA) and the left circumflex coronary artery (LCX) as culprit artery in inferior wall AMI. Only one previous study had ever used V3/III ratio as a criteria to predict infarct-related artery at three possible sites which had provided more extensively clinical use. This study was designed to identify the three possible sites of coronary artery in inferior AMI by new electrocardiographic criteria.
Methods and Results: Seventy-one patients who have no previous myocardial infarction or bundle branch block and whose first electrocardiogram was obtained less than 12 hours after the onset of chest pain were enrolled in this study. These patients were divided into three groups by confirmed coronary angiography, including culprit lesion before (proximal) and after (distal) the right ventricular branch of RCA and LCX. The ratio of ST elevation in lead III to lead II obtained from first surface electrocardiogram was used to determine the criteria. For culprit artery of proximal RCA, distal RCA, and LCX, III/II ratio was 2.1 ± 0.7, 1.6 ± 0.6, 1.0 ± 0.2 (P < 0.0001 ), respectively. According to the data of the receiver operating characteristic plot, III/II ratio > 1.8 was chosen to predict lesion at proximal RCA, III/II ratio was between 1.2 and 1.8 to predict distal RCA, and III/II ratio < 1.2 to predict LCX with sensitivity of 73%, 76%, 75%, and specificity of 88%, 79%, 92%, respectively.
Conclusion: The new electrocardiographic criteria with III/II ratio provided a simple, and useful method for early identification the culprit site of coronary artery in inferior wall AMI.

並列關鍵字

Electrocardiogram ； Acute myocardial infarction ； Coronary angiography ； Receiver operating characteristic

參考文獻

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