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冠状动脉左前降支(LAD)闭塞引起的急性前壁心肌梗塞(AMI)很少伴有下壁导联ST段抬高,而且也没有做过充分的调查和研究。本研究目的是验证下述假设,即前壁AMI伴有下壁导联ST段抬高,提示一种特殊的冠状动脉形态。方法本组由在北卡罗来纳大学医院接受心导管检查的前壁AMI病人组成,男33例,女9例,年龄57±12岁。在发病后平均4.1(0～14)天作冠状动脉造影。冠状动脉造影注意以下三个特征:(1)LAD远端闭塞;(2)LAD包绕至左心室下壁;(3)LAD发出侧支血管供应左心室下壁。后2个特征被认为对下壁透壁性缺血起了重要作用。结果 42例中有7例(16％)出现急性下壁导联ST段抬高(Ⅱ、Ⅳ、aVF导联ST段抬高幅度之和≥3mm)。而冠状动脉造影显示的LAD闭塞段近端侧支血管越多,则下壁导联ST段压低越少,有显著的相关性(r=0.59,P<0.01)。33例LAD包绕到下壁,9例则否。前者ST段压低幅度比后者小(0.2±4.0对3.0±2.8mm,P<0.05)。7
Acute anterior myocardial infarction (AMI) due to occlusion of the left anterior descending coronary artery (LAD) is rarely associated with ST-segment elevation of the inferior leads and has not been adequately investigated and investigated. The purpose of this study was to verify the hypothesis that ST-segment elevation in the anterior wall AMI with inferior leads leads to a specific coronary morphology. Methods This group consisted of anterior wall AMI patients undergoing cardiac catheterization at the University of North Carolina Hospital, 33 males and 9 females, aged 57 ± 12 years. After onset of an average of 4.1 (0 ~ 14) days for coronary angiography. Coronary angiography pays attention to the following three features: (1) distal occlusion of the LAD; (2) LAD wraps around the inferior wall of the left ventricle; (3) LAD sends a collateral blood vessel supplying the inferior wall of the left ventricle. The latter two features are thought to play an important role in transmural ischemia of the inferior wall. Results In 42 cases, 7 cases (16%) showed acute ST segment elevation of inferior leads (sum of ST segment elevation in Ⅱ, Ⅳ and aVF leads ≥3 mm). However, coronary angiography showed that the more proximal collateral vessels in the LAD occlusion segment, the lower the ST segment depression in the inferior leads was, the more significant correlation was found (r = 0.59, P <0.01). 33 cases of LAD wrapped around the wall, 9 cases were not. The former ST-segment depression was less than the latter (0.2 ± 4.0 vs. 3.0 ± 2.8 mm, P <0.05). 7