Study on the emergency ECG variation between proximal occlusion of left anterior descending artery and coronary blood flow recanalization in the patients with acute anterior wall ST-segment elevation myocardial infarction
Abstract：ObjectiveTo investigate the difference of emergency ECG under the circumstances proximal occlusion of left anterior descending(LAD) artery and coronary blood flow recanalization of the culprit vessels verified by emergency percutaneous coronary intervention(PCI) among the patients with acute anterior wall STsegment elevation myocardial infarction(STEMI). To judge the culprit vessel located in the proximal LAD artery in the patients with acute anterior wall STEMI according to ECG features, and to provide a simple and quick method for determining the necessity of blood flow recanalization. MethodsFortyone patients undergoing emergency PCI from January 2017 to October 2018 due to acute anterior wall STEMI were enrolled in this prospective study. According to the status of blood flow in LAD artery of the culprit vessel by emergency PCI, they were divided into proximal LAD occlusion group(20 cases) and coronary flow recanalization group(21 cases). Clinical manifestations and ECG characteristics were analyzed. ResultsThe clinical characteristics including sex, age, onset time of chest pain, renal function, electrolytes, medical history and vital signs at the time of visit did not vary significantly between the two groups. Coronary angiography verified that the ECGs of the two groups shared the common features that in the anterior leads STsegment elevation could be observed:≥20 mm elevation in lead V2-V4, <20 mm elevation in lead V1 and V5, and <10 mm elevation in lead V6. There existed differences between the two groups. In the proximal LAD occlusion group, STsegment elevation was≥10 mm in lead Ⅰ and aVL, STsegment depression was>10 mm in lead Ⅱ and Ⅲ, and STsegment depression was significantly(≥20 mm) in lead aVF. In the coronary flow recanalization group, STsegment elevation from equipotential line was<10 mm in lead Ⅰ and aVL while STsegment depression from equipotential line was<20 mm in lead Ⅱ, Ⅲ and aVF; shallow inversion of T wave in chest leads could be observed in parts of the patients. ConclusionFor the patients with acute anterior wall STEMI, emergency ECG could serve as a simple and quick method for differentiating between the occlusion of culprit vessel in proximal LAD artery and coronary flow recanalization.
王赛华, 郇强, 赵志宏, 陈琪, 方明, 田蓓, 宁忠平, 郑昌柱, 罗俊, 李新明. 急性前壁ST段抬高型心肌梗死左冠脉前降支近端闭塞与冠脉血流再通时急诊心电图改变研究[J]. 实用心电学杂志, 2019, 28(1): 21-26.
WANG Sai-Hua, HUAN Qiang, ZHAO Zhi-Hong, CHEN Qi, FANG Ming, TIAN Bei, NING Zhong-Ping, ZHENG Chang-Zhu, LUO Jun, LI Xin-Ming. Study on the emergency ECG variation between proximal occlusion of left anterior descending artery and coronary blood flow recanalization in the patients with acute anterior wall ST-segment elevation myocardial infarction. JOURNAL OF PRACTICAL ELECTROCARDIOLOGY, 2019, 28(1): 21-26.
2019, Vol. 28 
