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目的:探讨心电图(ECG)与冠状动脉造影(CAG)在急性前壁和前壁合并下壁心肌梗死(MI)患者中的应用价值。方法:选取2013-05-2014-11在我院治疗的急性ST段抬高型MI患者60例,分析总结患者ECG与CAG的特征。结果:60例患者中,CAG结果显示梗死相关动脉(IRA)为左冠状动脉前降支(LAD)50例,IRA为右冠状动脉(RCA)10例;以CAG结果为金标准,ECG判断IRA的灵敏度为96.00%,特异度为90.00%,误诊率为10.00%,漏诊率为4.00%,诊断一致性Kappa=0.760,P=0.000;LAD组V_3导联ST段抬高总和为(5.63±2.11)mm,明显高于RCA组的(2.26±1.13)mm(P<0.05);LAD组Ⅱ、Ⅲ、avF导联ST段抬高总和为(2.24±0.98)mm,低于RCA组的(3.62±1.69)mm(P<0.05);RCA组ST抬高V_1/V_3≥1以及ST抬高Ⅱ/Ⅲ≥1的患者比例分别为80.00%和70.00%,明显高于LAD组,差异有统计学意义(P<0.05)。结论:在MI患者中运用ECG定位IRA有一定的应用价值,但仍存在困难,CAG为确定IRA的金标准。
Objective: To investigate the value of electrocardiogram (ECG) and coronary angiography (CAG) in patients with acute inferior wall and anterior wall myocardial infarction (MI). Methods: Sixty patients with acute ST-segment elevation MI treated in our hospital from May 2013 to 2014-2014 were selected to analyze the characteristics of ECG and CAG. Results: In 60 patients, CAG results showed that IRA was 50 cases of left anterior descending coronary artery (LAD) and 10 cases of right coronary artery (IRA) in IRA. According to CAG results as gold standard and ECG as IRA The sensitivity was 96.00%, the specificity was 90.00%, the rate of misdiagnosis was 10.00%, the rate of misdiagnosis was 4.00%, the diagnostic concordance was Kappa = 0.760, P = 0.000. The sum of ST segment elevation of V_3 lead in LAD group was 5.63 ± 2.11 ) mm was significantly higher than that of RCA group (2.26 ± 1.13) mm (P <0.05). The sum of ST segment elevation of lead II, III and avF in LAD group was (2.24 ± 0.98) mm, lower than that in RCA group ± 1.69) mm (P <0.05). The proportion of patients with ST-elevation V_1 / V_3≥1 and ST-elevation Ⅱ / Ⅲ≥1 in RCA group was 80.00% and 70.00% respectively, which was significantly higher than that in LAD group Significance (P <0.05). CONCLUSIONS: The use of ECG to locate IRA in patients with MI has some practical value. However, it still has some difficulties. CAG is the gold standard for determining IRA.