Analysis Of The Correlation Between Electrocardiogram Manifestations And Coronary Angiography In Patients With Acute Non-ST-elevation Myocardial Infarction

Objective:To analyze the correlation between ECG features and coronary angiography(CAG)results in patients with acute non-ST-segment elevation myocardial infarction(NSTEAMI),and provide evidence for early diagnosis.Methods:Eighty patients with acute NSTEAMI were selected as subjects,and the general characteristics,disease history,12 leads ECG results of the seizure period,and emergency or selective CAG results were collected.12 leads ECG evaluation indicators include ST segment depression amplitude,ST segment depression numbers,QRS duration,and T wave inversion.ECG features grading:(1)ST segment depression amplitude was divided into three levels:normal,depression amplitude<1mm,depression amplitude ≥1mm;(2)ST segment depression numbers was divided into two levels:<6,≥6;(3)QRS duration was divided into<100ms and ≥100ms;(4)T wave inversion was divided into no inversion,T wave inversion<2mm and T wave inversion≥2mm.Number of coronary stenosis in CAG:single-vessel lesion,double-vessel lesion,three-vessel/three-vessel+left main lesion.Vascular stenosis:≥50%is stenosis with clinical significance,50%to 75%is mild stenosis,76%to 90%is moderate stenosis,91%to 99%is severe stenosis,and 100%is completely occluded.Data analysis was performed using SPSS 19.0 software.Results of the study:(1)General characteristics of the patients:80 patients aged 42-78 years,with an average age of 60.2±8.4 years;54 males and 27 females.Complicated diseases:the prevalence of hypertension,diabetes,hyperlipidemia,stroke,and atrial fibrillation were 71.5%,32.5%,77.5%,11.3%,and 5.0%,respectively.GRACE score at admission:<108 points in 23 cases(28.8%),109-140 points in 41 cases(51.2%),and>140 points in 16 cases(20.0%).(2)NSTEAMI ECG features at chest pain attack:The ST segment was seen to be down on the ECG when 62 patients were admitted to hospital.The proportions of ST normal,depression amplitude<1mm,depression amplitude ≥1mm were 22.5%,35.0%,and 42.5%;the proportion of ST segment depression numbers<6 and ≥6 were 53.7%and 46.3%,respectively.QRS duration:<100ms and ≥100ms accounting for 58.7%and 41.3%,respectively.T-wave inversion:T-wave without inversion,T-wave inversion<2mm and T-wave inversion>2mm are 17.5%,45.0%,and 37.5%,respectively.Pathological Q waves were observed in 7(8.8%)patients.The incidences of complete left bundle branch block(CLBBB)and complete right bundle branch block(CRBBB)were 2.5%and 6.3%,respectively.CAG examination results:the proportions of single-vessel lesion,double-vessel lesion,three-vessel/three-vessel+left main lesion were 8.8%,38.7%,and 52.5%respectively.The maximum degree of coronary stenosis:The proportions of 50%-75%,76%～90%,91%～99%and completely occluded were 11.3%,31.3%,35.0%,and 22.5%.(3)Correlation between NSTEAMI ECG features and coronary artery disease:①ST segment depression:The proportion of ST segment normal is highest in patients with single vessel lesion,accounting for 6.3%of the total number of patients,and the proportion of ST segment depression ≥1mm is highest in patients with three-vessel/three-vessel+left main lesion,reaching 32.5%;Spearman rank correlation analysis showed that the magnitude of ST-segment shift was positively correlated with the number of coronary lesions(r=0.448,P<0.001).There was no statistical correlation between the extent of ST-segment shift and the maximum degree of coronary stenosis(P=0.138).②ST segment depression numbers:The proportion of ST segment depression numbers<6 in patients with single-vessel lesion is significantly higher than ≥6(7.5%VS1.3%),the proportion of ST-segment depression numbers<6 in three-vessel/three-vessel+left main lesions was significantly lower than ≥6(20.0%VS 32.5%);The number of coronary artery lesions was correlated with the number of ST-segment leads(r=0.344,P=0.002).There was no statistical correlation between the degree of coronary stenosis and the number of ST-segment leads(P=0.285).③QRS wave duration:The proportion of patients with single-vessel lesion with QRS wave time<100ms is significantly higher than that of ≥100ms(8.8%VS 0.0%),the proportion of patients with three-vessel/three-vessel+left main lesion of QRS wave<100ms was significantly lower than that of ≥100ms(20.0%VS 32.5%);Spearman rank correlation analysis showed that the number of coronary lesions was positively correlated with the QRS wave duration(r=0.458,P<0.001),and maximum coronary stenosis was positively correlated with the QRS wave duration(r=0.292,P=0.009).④ T wave inversion:Spearman rank correlation analysis showed that there was no statistical correlation between T wave inversion and the number of coronary lesions and the maximum degree of stenosis(P>0.05).Conclusion:(1)NSTEAMI patients of ST segment depression ≥1mm,QRS wave duration≥100ms,ST segment depression number ≥6 have higher risk of multiple coronary lesions,which may have extensive and persistent myocardial ischemia,vigorous measures should be taken to protect surviving cardiomyocytes.(2)Early ECG detection can be used as a preliminary diagnostic tool for high-risk acute non-ST-segment elevation myocardial infarction,which has guiding value for patients’ risk stratification and treatment planning.