Value Of Augmented Unipolar Limb Lead To Predict The Culprit Vessel In Acute Myocardial Infarction

Objective: To assess the characters of 12-leads or 15-leads electrocardiogram ST-segment and QRS wave group changing, especially augmented unipolar limb lead (aVR, aVL, aVF) and predict the infarct-related artery in the acute myocardial infarction.Method: Collecting the electrocardiogram and the coronary angiography of the patients with acute myocardial infarction in the first affiliated hospital of Nanchang University from 2007 to 2009 and retrospectively analyzed. The electrocardiogram was registered within 12 hours after the acute episode, and underwent coronary angiography within one week. 132 patients were collected, which included 107 with ST-segment elevation myocardial infarction (STEMI), 25 with Non-ST-segment elevation myocardial infarction (NSTEMI).Results: The acute inferior myocardial infarction from right coronary artery occlusion group and the left circumflex artery occlusion group in theⅠ, aVL, V1, V6 leads ST segment deviation on the degree of statistically significant differences,Ⅰ, aVL leads ST-segment depression in the right coronary artery occlusion group were significantly (P values were 0.035 and 0.001), V1 ST-segment down in the left circumflex artery occlusion group was more apparent (P=0.001), and aVR ST-segment changes in the two groups did not differ (P = 0.357), also obtain aVL lead ST-segment depression ,STⅢ↑> STⅡ↑and STaVL↓> STⅠ↓strongly suggests the infarct-related artery of acute inferior myocardial infarction is right coronary artery . Inferior myocardial infarction if accompanied V6 ST-segment elevation in the diagnosis of left circumflex artery occlusion had a sensitivity of 50%, specificity was 97%, and accuracy was 86%, positive predictive value 85% negative predictive value of 88%. Using ROC curve analysis of these changes on the difference between the value of the two groups suggest the culprit vessel, come aVL lead ST-segment depression diagnostic value of most, the area under the curve to 0.915. Right coronary artery occlusion group aVL ST-segment depression in 38 patients (depression >1mm, 28 cases),left circumflex artery occlusion group were 8 cases of ST-segment depression (depression>1mm 0 case).When the infarct-related artery is right coronary artery, the chest leads ST segment deviation in the number of occlusion in the proximal and distal occlusion between the two groups was significant difference (χ~2=16.009,P=0.007),when more than four leads and the more common proximal right coronary artery occlusion. V1, V2 ST-segment depression is also common in the right coronary artery proximal occlusion group. . Right ventricular leads (V3R, V4R and V5R) ST segment elevation on the diagnosis of right coronary occlusion is important, the specificity 100%, and almost all proximal occlusion of right coronary artery. Anterior myocardial infarctionⅠ, aVR, aVL leads ST-segment elevation andⅡ,aVF leads ST-segment depression prompt for the left anterior descending artery occlusion in the proximal (P values were 0.004, 0.007, 0.015,0.022,0.004), 12 leads ST-segment total number of shifts between the two groups were significantly different. With ROC curve analysis of these changes on the difference between the values of two blocking parts of the tips, which come 12 leads ST-segment total number of shifts in the best position to suggest proximal left anterior descending artery occlusion, area under the curve to 0.899. Pathologic Q wave in lead aVL is seen occur proximal left anterior descending artery occlusion and left main coronary artery occlusion, diagnosis of left anterior descending artery proximal occlusion of the sensitivity was 36%, specificity was 89%, accuracy was 55%, positive predictive value of 87%, negative predictive value of 43%. Non-ST segment elevation myocardial infarction more common in multi-vessel disease, with ST elevation myocardial infarction with significant statistical difference (χ2 = 5.945, P = 0.017).Conclusion: The acute inferior myocardial infarction aVL lead ST-segment depression>1mm, STⅢ↑> STⅡ↑and ST aVL↓> STⅠ↓tips right coronary artery occlusion. Acute inferior myocardial infarction accompanied by ST segment elevation in lead V6 tips left circumflex artery occlusion. Right coronary artery occlusion, and over four chest leads ST-segment deviation suggests proximal occlusion of right coronary artery. Right ventricular leads ST-segment elevation prompt proximal right coronary artery occlusion. Acute anterior myocardial infarctionⅠ, aVR, aVL ST-segment elevation andⅡ,aVF leads ST-segment depression or pathologic Q wave aVL lead prompt appears proximal left anterior descending artery or left main coronary artery occlusion. Acute anterior myocardial infarction 12 ST-segment level of the total offsets> 10mm prompted proximal left anterior descending artery occlusion. Non-ST segment elevation myocardial infarction there is more than two or three vessel disease.