目的 探讨急性前壁心肌梗死患者的体表心电图对左主干病变的预测价值.方法 对112例急性前壁心肌梗死患者的体表心电图(ECG)和冠状动脉造影资料进行回顾性对比分析,其中左主干病变24例(LM组),左前降支病变88例(LAD组).结果 LM组STavR及STv6导联抬高幅度显著高于LAD组,分别为(1.21±0.49)mV vs(0.28±0.38)mV(P＜0.01);(1.10±0.54)mV vs(0.60±0.83)mV(P ＜0.01).LM组STv1导联抬高幅度显著小于LAD组,(0.79±0.44) mV vs(1.49±1.04) mV(P＜0.01).LM组STaVR抬高、STavR抬高≥STv1抬高、STv6抬高≥STv1抬高的出现率显著高于LAD组,83.3％ vs 50.0％(P ＜0.01);83.3％ vs 3.4％(P＜0.01);79.2％ vs25.0％(P＜0.01),而STv1抬高的出现率显著低于LAD组,62.5％ vs 90.9％(P＜0.01).STavR抬高、STavR抬高≥STv1抬高、STv6抬高≥STv1预测左主干病变的敏感度分别为83.3％、83.3％、79.2％,特异度分别为50.0％、96.6％、68.2％.结论 急性前壁心肌梗死时,体表ECG对左主干病变有重要的预测价值.%Objective To investigate the value of electrocardiogram(ECG) in predicting left main(LM) coronary artery obstruction in patients with anterior wall acute myocardial infarction. Methods The data of ECG and coronary angiographic findings in 112 patients with anterior wall acute myocardial infarction were comparatively analyzed, 'including 24 cases of LM occlusion and 88 cases of left anterior descending (LAD) occlusion. Results Significantly higher ST segment elevation in lend aVR and V6 were observed in LM group than in LAD group (1. 21±0.49) mV vs (0.28±0. 38) mV( P <0. 01) ;(1.10±0. 54) mV vs (0. 60±0.83) mV( P <0. 01). ST segment elevation in lend V, was significantly lower in LM group than in LAD group ( 0. 79 ± 0. 44 ) mV vs (1. 49 ± 1.04) mV ( P < 0. 01). The ratio of patients with ST.vs elevation. ST.vn elevation ≥ ST1, elevation. STv, elevation ≥ ST1, elevation were significantly higher in LM group than in LAD group,83. 3% vs 50. 0% ( P <0. 01);83. 3% vs 3. 4%( P <0.01); 79. 2% vs 25. 0%( P<0. 01). The ratio of patients with STVl elevation was significantly lower in LM group than in LAD group,62. 5% vs 90. S%( P <0. 01). The sensitivities of ST,VR elevation,ST.VR elevation^ STV, elevation and STV6 elevation≥STV1 elevation were 83. 3% ,83.3% ,79. 2% ,the specificities were 50. 0% ,96. 6% ,68. 2%. Conclusion ECG has significant value in predicting LM coronary artery obstruction in patients with anterior' wall acute myocardial infarction.
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