The Clinical Significance Of ST Segment Changes Of AVR Lead In Patients With Acute Myocardial Infarction

Objective:To investigate the value of ST segment changes of aVR lead in identifying the infarction related artery(IRA) and prognosis in patients with acute myocardiai infarction(AMI).Method:Collected in October2010to December2012with acute myocardiai infarction patients in our hospital300cases (male202, female98). All patients were accord with the2010criteion of Chinese Medical Association diagnostic criteria for AMI:chest pain>30minutes, including taking nitroglycerin is invalid;clectrocardiogram characteristics or dynamic change; Troponin I (cTNI) more than upper limit of normal value and dynamic change. Must have two or more than two of these standards can be selected.Exclusion criteria:nearly (<6months) in major surgery, trauma; contraindications to anticoagulation and antiplatelet therapy:hemorrhagic cerebrovascular accident and cerebral hemorrhage or half a year old in cerebral ischemic cerebrovascular accidents, such as hemorrhagic disease or thrombocytopenia; aspirin and contrast allergy; severe liver, kidney damage; severe electrolyte disorder, atrial flutter and atrial fibrillation ST segment can’t accurate measurement.(1) According to the patients on admission of12lead ECG lead aVR ST segment changes, divided into group A (lead aVR st-elevation)80cases and group B (lead aVR no raised ST segment) of160cases and group C (lead aVR ST segment down)60cases. In accordance with the group A lead aVR degree of ST segment elevation is divided into two subtribe:I group of30patients (0.05mV or less lead aVR st-elevation<0.1mV) and Ⅱ group of50cases (lead aVR st-elevation 0.1or higher). Patients with time window within12hours of stroke onset for thrombolysis or direct PCI treatment, all patients during hospitalization were type of coronary artery angiography(coronary angiography, the CAG), and according to the judging by coronary angiography infarction related artery.Infarction related artery ruled:①filling defect occlusion;②tenosis site,local contrast agents were stranded or residual stenosis and other characteristics,③if the infarction related artery recanalization, its position is the most narrow part of the block. Details to be included in the general data, including age, gender, infarction area, type of infarction, high blood pressure, diabetes, etc. Clinical data of patients, coronary angiography results and hospitalization period of major adverse cardiovascular events (major adverse cardiac event, MACE)(psychogenic death, severe heart failure, malignant arrhythmia, non-fatal myocardial infarction and target blood vessels reascularization) incidence were compared. All data using SPSS16.0software is analyzed, with comparison between groups (P<0.05), group comparison (P<0.016) is statistically significant. Result:Three groups of coronary arteriography lesion blood vessel position, group A left main (LM) and the left anterior descending (LAD) in lesion proportion (85.0%), significantly more than the other two groups, group C right coronary artery (RCA) and the left circumflex (LCX) team lesion proportion (83.3%), significantly more than the other two groups. Lead aVR ST elevation of left main Sensitivity (Se), Specificity (Sp), positive predictive value,(positive predictive value, PPV) and negative predictive value, negative predictive value, NPV) were69.2%,74.6%,22.5%and69.2%respectively; ST segment of aVR elevation of LM in sensitivity, specificity, positive predictive value and negative predictive value were55%,93.2%,85%and93.2%; for RCA and LCX the sensitivity and specificity is poorer, lead aVR ST down of LCX and RCA sensitivity, specificity, positive predictive value and negative predictive is respectively71.4%,88.4%,50.0%,95.%and30.3%,82.9%, 33.3%,82.9%; ST segment of aVR down for LM and LAD to the recent poor sensitivity and specificity;(4) three sets of in-hospital MACE events, group A and group C clinical cardiac events (non-fatal myocardial infarction, severe heart failure, malignant arrhythmia, psychogenic death) than in group B (P<0.01), statistically significant differences, group A compared with group C (P>0.05), no statistical difference;(5) A set of two subgroups (Ⅰ and Ⅱ) no statistical difference in clinical data; and II group in the incidence of a disease of left main, three vascular lesions and clinical cardiac events were significantly more than the I group (P<0.05)statistically differences;6. Lead aVR ST elevation values (OR=4.77,95%CI=2.56-8.92, P<0.01) and the value of aVR lead ST down (OR=5.22,95%CI=2.67-10.21, P<10.21) in patients with acute myocardial infarction occurred MACE is an independent predictor of incident. Conclusion:1. ST segment changes (up and down) of aVR lead is uesful for predicting the number of infarction vessels, parts and the incidence of clinical major adverse cardiovascular events in patients with acute myocardial infarction,;2. The greater the ST segment elevation of aVR lead, the higher the rate of left main stem and three vascular coronary disease and the incidence of clinical cardiac events;3ST segment changes (up and down) of aVR lead has certain clinical guiding sinificance for predicting infarction-related artery and prognosis in patients with acute myocardial infarction.