The Study Of Electrocardiogram In Distinguishing The IRA In Patients With Acute Inferior Wall Myocardial Infarction Of ST Segment Elevation

Objective: To investigate the difference of electrocardiogram between inferior wall myocardial infarction patients of ST segment elevation with multi-vessel disease and single-vessel disease;To study the predictive value of electrocardiogram in distinguishing the IRA of patients with acute inferior wall myocardial infarction.Methods:1. One hundred and ninety-two patients with acute inferior wall myocardial infarction of ST segment elevation from June 2012 to June 2014 were selected 2. The 12 leads ECG of the patients were recorded before primary percutaneous coronary intervention.3.On the second day after admission, fasting blood was drawn to measure the level of biochemical index by fully automatic biochemical analyzer,the level of cardiac troponin I(c Tn I) by immune method of gold tag technology and the level of routine blood related indicators by automatic classification of five blood cell analyzer,the level of NT-pto BNP by automatic electrochemical luminescence analyzer.Results:1.All the patients were divided into RCA single-vessel disease group(n=71), RCA multi-vessel disease group(n=73), LCX single-vessel disease group(n=22), LCX multi-vessel disease group(n=26) according to the coronary angiography results. 2.When RCA was IRA,the narrowed artery was always LCX;The narrowed artery was always LAD,when the IRA was LCX.3.compared with RCA single-vessel disease group,the multi-vessel disease group always have a more ST segment depression in lead V4[(-0.97±0.43)mm VS(-0.61±0.47)mm,P<0.01], STE Ⅲ>STⅡ and STD V4≥0.8mm is meaningful in predicting RCA multivessel-disease, with a sensitivity of 72.6% and a specificity of 78.1%; compared with LCX single-vessel disease the group,multi-vessel disease group always have a more ST segment depression in lead V3 and V4, respectively[(-2.14±0.48) mm VS(-1.83±0.49)mm, P<0.05 ] and [(-0.86±0.44) mm VS(-0.49±0.40)mm,P<0.01].The sensitivity and specificity of STE Ⅲ/Ⅱ≤1 and ST D V4≥0.5mmin predicting LCX multi-vessel disease is respectively 69.2% and 92.1%.4. STE Ⅲ/Ⅱ>1is meaningful in predicting as RCA as IRA,with a sensitivity of 95.1% and a specificity of 85.4%;the sensitivity of STD a VL>Ⅰin predicting RCA as IRA is 88.2%;STE V1 and STD V3/STE Ⅲ<1.2 have a high specificity in predicting RCA as IRA,respectively, 100%and91.7%; STE Ⅲ/Ⅱ≤1 showed a higher sensitivity and specificity in predicting LCX as IRA,respectively 85.4% and 95.1%;STE Ⅰ、STD a VR、STE V5 or V6 have a high specificity in predicting LCX as IRA,respectively 92.6%、95.1%和94.4%.Conclusions: 1、Patients with acute inferior wall myocardial infarction always have a infarction related artery of right coronary artery, The companied narrowed artery was always LCX, When patients are RCA multi-vessel disease.2.Compared with RCA single-vessel disease group multi-vessel disease group tend to has a more ST segment depression in lead V4. Compared with LCX single-vessel disease group multi-vessel disease has a more ST segment depression in lead V3 and V4. STE Ⅲ/Ⅱ>1 and STE V4≥0.8mm can be used to predict RCA multi-vessel disease;STE Ⅲ/Ⅱ≤1 and STE V4≥0.5mm can be used to predict LCX multi-vessel disease. 3.STE Ⅲ/Ⅱ>1 has a high sensitivity and specificity in predicting RCA as IRA,STD a VL>Ⅰis a sensitive indicator in predicting RCA as IRA,STE V1 and STD V3/STE Ⅲ<1.2 is a specific indicator in predicting RCA as IRA;STE Ⅲ/Ⅱ≤1 shows a high sensitivity and specificity in predicting LCX as IRA.In our study,we always find that STE V5 or V6 have a high specificity in predicting LCX as IRA.