| Objective: the aim of this study was to assess the character of 12-leads electrocardiographic ST-segment changing especially lead aVR ,in acute coronary syndrome ,namely to predict the proximal to the left anterior descendingcoronary artery(LAD) occlusion in patients with acute anterior myocardial infarction(AAMI) , to identify the patients' infarct-related artery(IRA) with acute inferior myocardial infarction(AIMI) and high-risk patients with 3-vessel or left main stem coronary artery disease in unstable angina pectoris (UA).Methods: All admitted patients underwent conventionally electrocardiogram (ECG) and coronary angiography (After admitted to our hospital,patients with acute myocardial infarction underwent immediate CAG or in the 10 days , patients with unstable angina pectoris underwent CAG in a week ). 89 patients' ECG with AAMI ,of these patients ,proximal to LAD occlusion was present in 43 distal to LAD in 46; 65 patients' ECG with AIMI,of these patients,proximal to the right coronary artery(RCA) occlusion was present in 26 distal to RCA in 29 left circumflex coronary artery (LCX) occlusion in 10, was registered in 12 hours after the acute episode. 155 patients' ECG with UA,of these patients, 1-vessel coronary artery disease(CAD) was present in 83 2-vessel CAD in 32 3-vessel CAD in 27 and left main CAD in 13, was noted during chest pain,then compare the ECG with the CAG.Results: In AAMI : Compare the ECG of PS with DS, marked ST↑ in precordial lead showed no significant. ST↑ avr and ST ↓ II, III, avf in PS showed significant ( 0.94 ±0.48mm VS 0.30 ±0.56mm ,P=0.021; -1.21±0.72mmVS-0.64±0.53mm,P=0.010; -1.63±0.92mmVS-0.98±0.39mm, P=0.016; -1.40±0.66mm VS-0.85±0.32mm, P=0.000) .At the same timeof marked ST t in precordial lead, the sensitivity (Se) specificity(Sp) coincidence rate(CR) positive predictive value(PPV) negative predictive value(NPV) of ST ↑ avr as predictor of the proximal to the LAD occlusion was 47% 93.48% 77.53% 89.66% 71.67% respectively. In AIMI: Compare the ECG of proximal to the right ventricular branch (PRV) distal to the right ventricular branch(DRV) with left circumflex coronary artery (LCX), marked ST t in inferior lead showed no significant. ST I aVR in right coronary artery occlusion and ST I vi. V2. V3 in non-PRV group showed significant (-O.81+O.53mm . -0.81±0.63mm VS -0.19±0.19mm, P=0.046; -0.16 +0.39mm VS -1.14 +0.82mm. -1.08 + 0.97mm, P=0.006; -0.34 + 0.46mm VS-1.54± 1.20mm. -2.06+1.24mm, P=0.000; -0.45 + 0.44mm VS-1.52 + 1.17mm. -2.56+ 1.32mm, P=0.000) . At the same timeof marked ST t in inferior lead, the Se. Sp. CR. PPV. NPV of ST I avR as predictor of RCA occlusion was 58.18%. 90.00%. 63.08%. 96.67%, 28.13% respectively; Se. Sp. CR. PPV. NPV of ST I aVR and ST I vi. V2. V3 as predictor of distal toRCA occlusion was 34.48-51.72%. 83.33-94.44%. 67.69-70.77%. 71.43-83.33%. 64.15-68.89%.Moreover in AIMI, ST t m>ST t ii and ST \ avL>ST 11 can identify RCA occlusion. In UA , Compare the ECG during chest pain with during no chest pain, ST \ \. u. 3vl. V3-V6 and ST t 3vr showed significant during the episode of chest pain. Se. Sp. CR. PPV. NPV of ST t aVRas predictor of 3-vessel or left main stem coronary artery disease was 85.19% and 84.62%. 76.52% and 76.52%. 78.17% and 77.34%. 46.00% and 28.95%. 95.65% and 97.78% respectively.Conclusion: In AAMI, at the same time of ST t in precordiol lead, ST t 3vr and /or ST I in inferior lead was useful for identifying proximal to LAD occlusion . In AIMI, at the same time of ST t in inferior lead ,ST \ 3vr can identify proximal to RCA occlusion ; ST I avR and ST I vi. V2. V3 can identify distal to RCA; ST I vi. V2. V3 can identify LCX occlusion .Moreover in AIMI, ST t m>ST f n and ST I avL>ST I i can identify RCA occlusion.In UA, ST t 3vr and ST I i. n. avL. V4~V6 during the episode of chest pain was useful for identifying 3-vessel or LMS coronary artery disease .
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