Clinical And Culprit Coronary Correlation Analysis Of De Winter Pattern ECG

Objective: To investigate the correlation between the different forms ST segment of De Winter ECG and coronary artery lesions and clinical features.Methods: From January 2019 to December 2019,1525 patients with acute coronary syndrome who underwent coronary angiography due to chest pain in the First Affiliated Hospital of Chongqing Medical University were screened for De Winter ECG(ST segment depression with high and peaked T wave in chest lead),A total of 46 cases were included.According to the results of ECG,the selected patients were divided into different group.According to the ST-segment depression morphology of the thoracic lead,the patients were divided into the upslope depression group,the horizontal depression group and the downslope depression group.According to the ST segment morphology of the inferior wall lead and the existence of pathological Q wave,they were divided into inferior wall elevation group,inferior wall depression group,inferior wall normal group,and inferior wall Q wave group.The clinical features(gender,age,BMI,smoking history,alcohol consumption history,hypertension,diabetes,dyslipidemia,cardiogenic shock,hospital death,ventricular fibrillation and Killip grade)and the characteristics of coronary artery lesions were compared between the groups.Results: 1.The clinical characteristics of the upslope depression group,the horizontal depression group and the downslope depression group were compared.The patients with hypertension history in the downslope depression group were more than the horizontal group(85.7% vs.31.2%,P=0.026).The incidence of cardiogenic shock in the upslope depression group was higher than that in the horizontal depression group(35.3% vs.0.0%,P=0.004).2.By comparing the differences in coronary artery diseases among the upslope depression group,the horizontal depression group and the downslope depression group,the incidence of left anterior descending coronary artery and right coronary artery double-branch severe stenosis in the group of horizontal depression was lower than the downslope depression group(0.0% vs.42.9%,P=0.010);the incidence of three-branch severe stenosis in the group of horizontal depression was higher than the downslope depression group(54.5% vs.0.0%,P=0.035).The difference in coronary artery disease among the remaining groups was not significant(P >0.05).3.Comparing the differences of coronary artery disease among the inferior wall elevation group,the inferior wall depression group,the inferior wall normal group,and the inferior wall Q-wave group,among the 46 De Winter ECG cases,the incidence of left anterior descending coronary artery and left circumflex double branch severe stenosis in the inferior wall elevation group was lower,compared with the inferior wall depression group(0.0% vs.66.7%,P=0.001)and the inferior wall normal group(0.0% vs.30.8%,P=0.015).The incidence of three-branch severe stenosis in the inferior wall Q-wave group was higher than the inferior wall normal group(83.3% vs.15.4%,P=0.010).The difference in coronary artery disease among the remaining groups was not significant(P >0.05).Conclusion: The different depressions of ST segment of thoracic lead and the accompanying inferior wall lead have certain reference value for the judgment of myocardial ischemia degree.The incidence of cardiogenic shock was higher in patients with upslope depression of ST segment in thoracic lead,and the incidence of three branches of severe stenosis was higher in patients with horizontal depression and with Q wave in inferior lead,suggesting that the patients had relatively severe myocardial ischemia and poor prognosis.