Relationship Of ECG Changes Of Acute Myocardial Infarction With The Results Of Coronary Angiography

Background and Objective：Background: The acute myocardial infraction’s characteristic is acute onset, morecomplications, high mortality, high disabililty and worse prognosis. Along with thedeepening of research, from the body surface electrocardiogram(ECG) to the clinicalapplication of myocardial enzymes and myocardial injury markers detection, to the carryingout of emergency coronary angiography, clinical diagnosis and treatment of AMI have madea landmark development. Studies have demonstrated that there are differences in clinicalmanifestations of myocardial infarction with different vascular lesions. In recent years, therelationship between the infarction-related artery with ECG has a certain understanding aftera large number of coronary angiography were carryed out, however, only a minority ofpatients with AMI can underwent emergency coronary angiography and timely reperfusiontherapy. Therefore, early identification of infarction-related artery is beneficial to the outlookfor patients. The judgment of infarction-related artery is contribute to estlimate the area ofmyocardial necrosis and pays more attention to the occurrence of heart failure, arrhythmiaand other early complications. In addition, due to the NSTEMI clinical manifestationdiversity and atypical ECG finding, doctor didn’t give insufficient attention in the past. Asthe myocardial injure markers testing sensitivity was improved, now diagnosis rate ofpatients with NSTEMI is gradually increasing. A number of coronary angiography showedcoronary aryery lesions in the patients with NSTEMI are severe than expected. Earlycoronary interventional therapy can significantly improve the prognosis of the patients,especially in high-risk patients.Objective: In this study, a retrospective analysis was performed on the results of ECGand coronary angiography in133cases of patients with AMI, to analyze the relationship ofECG characteristics with the result of coronary angiography, and to comparise the featuresof coronary artery lesions in patients with STEMI and NSTEMI, in order to deepen the understanding of ECG and coronary artery characteristics, to provide the reference forclinicians who can’t carry out emergency coronary angiography. In case of no emergencycoronary angiography, clinicians can accurately recognition AMI as soon as possible，thenjudge infarction position and size, predicte the culprit artery, so that they can make rightclinical decision, improving the early and long term prognosis of patients.Materials and Methods：The study objects were selected from hospitalize patients with AMI in the First Hospitalof Jilin University since January2011and June2011, including97men and36women. Theaverage age was59.74±10.89years old. All patients underwent coronary angiography wereincluded and divided into STEMI group(86cases) and NSTEMI group(47cases). AMIdiagnostic criteria based on the "unstable angina and non ST-segment elevation myocardialinfarction diagnosis and treatment guidelines"developed in2007and "acute ST-segmentelevation myocardial infarction diagnosis and treatment guidelines"enacted in2010.Allpatients measured with electrocardiographic examination within12hours and underwentcoronary angiography onset or3-5days after admission.STEMI group and NSTEMI grouppatients’ ECG and CAG results were contrastive analysis. Statistical methods: UsingSPSS18.0Chinese version software for data statistics analysis, the measurement data resultswere presented as mean±standard deviation (±S),and the count data using X2test, whiletheoretical frequency <1or the total number of samples <40, inspection by Fisher’s exactprobability. All statistics were made bilateral test, P <0.05was considered statisticallysignificant.Result：1. Anteroseptal, anterior, extensive anterior wall myocardial infarction predictedLAD lesions accuracy as high as98.0%.2. Involving the inferior wall acute myocardial infarction, the lesion vessels wereRCA (83.3%) or LCX (16.7%); simple inferior wall myocardial infarction can also becaused by LCX lesions; while the culprit arterys of inferior wall&right ventricular wall&postior wall all were RCA. 3. LCX occlusion in NSTEMI group accounted for50%, LAD occlusion in STEMIaccounted for51.61%, the differences have statistical significance (p<0.05).4. Compared the coronary artery stenosis degree of patients in two groups: InNSTEMI group moderate stenosis accounted for23.41%and severe stenosis accounted for40.43%;while in STEMI group the culprit vascular occlusion accounted for72.09%, thedifferences have statistical significance (p<0.05).5. Compared the coronary artery lesion counts of patients in two groups: In NSTEMIgroup three branch lesion accounted for48.93%;while in STEMI group single branch lesionaccounted for46.51%, the differences have statistical significance (p<0.05).6. In NSTEMI group, ST segment depression subgroup patients with severe stenosisaccounted for57.14%, with collateral circulation accounted for9.52%;while the lack STsegment depression subgroup with moderate stenosis accounted for38.46%, with collateralcirculation accounted for9.52%.Conclusion：1. ECG can predicte culprit arterys of AMI with high precision.2. NSTEMI with culprit vascular occlusion mainly were LCX, while STEMI withcriminal vascular occlusion mainly were LAD.3. Vasculars of NSTEMI have severe stenosis, and three vessel stenosis are morecommon, the clinical prognosises are no well than STEMI, so clinicians should pay moreattention to it, trying to early carry out vascular reperfusion.4. NSTEMI with ECG ST segment depression predicts coronary artery seriousstenosis.