Approach And Significance Of Determining Culprit Vessel In Acute Inferior Myocardial Infarctionacute By ECG

Objective:To investigate the approach and process for diagnose ST segment elevation AIMIculprit vessel by ECG, as well as the clinical significance to recognize culprit vessel.Methods:The clinical data on a total of193ST segment elevation AIMI patients who weresubject to acute PCI treatment was admitted into the hospital from May2007toSeptember2013was collected. Participants were divided into2groups: RCAocclusion (group A) and LCX occlusion (group B). And group A was further dividedinto proximal-middle RCA occlusion (group C) and distal RCA occlusion (group D).By comparisons among the ECG changing characteristics of different groups, theECG indexes of culprit vessels were summarized and determined, the predictive valueof each index was evaluated and a diagnose process was established. The differencesin cardiovascular event among the patient groups were compared during theirhospitalization.Results:1. The approach to determine RCA or LCX of culprit vessels: step1:ST↑≥0.05mv in lead V4R or Ⅲ°AVB is a sign to identify RCA. Step2: ST↓≥0.05mvin lead I and AVL is a sign to identify RCA; ST↑or equipotential line in lead I andAVL is a sign to identify LCX. Step3: ST↑in lead II/ST↑in lead III≥1is a sign toidentify LCX. Step4: ΣST↓in lead V1, V2and V3/ΣST↑in lead II, III and AVF≤1isa sign to identify RCA; ΣST↓in lead V1, V2and V3/ΣST↑in lead II, III and AVF>1is a sign to identify LCX.2. The approach to determine proximal-middle RCA or distal RCA of culpritvessels: Step1: ST↑≥0.05mv in lead V4R or Ⅲ°AVB is a sign to identifyproximal-middle RCA. Step2: ST↓>0.1mv in lead I is a sign to identifyproximal-middle RCA. Step3: ST↓≥0.2mv in lead AVL is a sign to identifyproximal-middle RCA. Step4: ST↑>0.25mv in lead III is a sign to identify proximal-middle RCA, ST↑≤0.25mv in lead III is a sign to distal RCA3. The incidences of implanting temporary pacemaker and IABP in RCAocclusion (group A) are higher than those of LCX occlusion (group B). Theincidences of reperfusion arrhythmia, and implanting temporary pacemaker and IABP,ventricular arrhythmias event during hospitalization in proximal-middle RCAocclusion (group C) are higher than those of distal RCA occlusion (group D).Conclusion:ECG analysis can determine the part of culprit vessel in a rapid and accurate way,thus evaluating illness degree and guiding treatment.