| Objective: Explore clinical significance of Ⅱ、Ⅲ、aVF ST segment downduring anterior acute myocardial infarction.Method:Collected in March2012to December2013with anterior acute myocardial infarction patientsin our hospital286cases （male181,female105）.Inclusioncriteria:Selected patients were accord with the ACC/AHA2009diagnosticcriteria for acute myocardial infarction: chest pain>30minutes,including taking nitroglycerin is invalid;Electrocardiogram (ECG)characteristics or dynamic change;myocardial enzyme seriesrises.Exclusion criteria: nearly (<6months) in major surgery, trauma;Contraindications to anticoagulation and antiplatelettherapy:hemorrhagic cerebrovascular accident and cerebral hemorrhage orhalf a year old in cerebral ischemic cerebrovascular accidents, such ashemorrhagic disease or thrombocytopenia; Aspirin and contrast allergy;Severe liver, kidney damage; Severe electrolyte disorder, atrial flutterand atrial fibrillation ST segment can’t accurate measurement.(1)according to the patients Ⅱ、Ⅲ、aVF ST segment changes, divided intogroup A (ST segment down<0.1mv)132cases and group B (ST segment down≧0.1mv)154cases, patients with time window within12hours of strokeonset for direct PCI treatment, all patients during hospitalization weretype of coronary artery angiography(coronary angiography, the CAG), andaccording to the judging by coronary angiography infarction related bloodvessels (infarction related artery, IRA).Infarction related artery (IRA)ruled that have filling defect occlusion and stenosis site. Local contrastagents were stranded or residual stenosis and other characteristics, ifthe infarction related artery recanalization, its position is the most narrow part of the block. Details to be included in the general data,including age, gender, infarction area, type of infarction, high bloodpressure, diabetes, hyperlipemia etc. Clinical data of patients, coronaryangiography results cardiac ultrasound results and hospitalizationperiod of major adverse cardiovascular events (major adverse cardiacevent, MACE)(psychogenic death, severe heart failure, malignantarrhythmia, non-fatal myocardial infarction) incidence were compared.Alldata using SPSS19.0software is analyzed.Result: The clinical basic data of two groups is no statistical difference. Two groups of LVEF(P <0.01), statistically significant differences. Two groups ofcoronary arteriography lesion blood vessel position, group A the distal leftanterior descending (LAD) significantly more than the other group,group B theproximal LAD significantly more than the other group.Lead Ⅱ、Ⅲ、aVF ST segmentdown<0.1mv of left main Sensitivity (Se), Specificity (Sp), positive predictive value,(positive predictive value, PPV) and negative predictive value, negative predictivevalue, NPV) were44.4%、53.7%、6.1%and93.5%respectively; Lead Ⅱ、Ⅲ、aVF STsegment down<0.1mv of the proximal LAD sensitivity, specificity, positive predictivevalue and negative predictive is respectively13.3%、24.5%、13.6%、24%;Lead Ⅱ、Ⅲ、aVF ST segment down<0.1mv of the distal LAD sensitivity, specificity, positivepredictive value and negative predictive is respectively83.3%、79.7%、75.8%、87%;Lead Ⅱ、Ⅲ、aVF ST segment down≧0.1mv of LAD and the proximal LAD andthe distal LAD sensitivity, specificity, positive predictive value and negativepredictive is respectively55.6%、46.3%、6.3%、93.9%，86.7%、75.5%、76.0%、86.4%and16.7%、20.3%、13.0%、24.2%;④two sets of in-hospital MACE events,group B clinical cardiac events (non-fatal myocardial infarction, severe heart failure,malignant arrhythmia, psychogenic death) more than group A(P <0.01), statisticallysignificant differences.Conclusion:1. ECG lead Ⅱ、Ⅲ、aVF ST down on anterior acute myocardialinfarction,cardiac function,the part of lesion vessels and clinical cardiac events has higher predictive value;2. The more lower of the lead Ⅱ、Ⅲ、aVF ST,The worsethe cardiac function, and the higher the rate of the clinical incidence of cardiacevents.3.The more lower of the lead Ⅱ、Ⅲ、aVF ST,indicating IRA more happento the distal LAD. |
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