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目的:探讨前壁急性心肌梗死(AMI)合并下壁导联ST段压低的临床意义。方法:回顾性分析29例前壁AMI患者的心电图、选择冠状动脉造影,评估左冠状动脉前降支(LAD)梗死相关病变与第一对角支(D1)开口的位置关系。结果:29例前壁AMI患者,伴下壁导联ST段压低12例中,以D1开口前的LAD病变或LAD合并D1病变9例(75.00%),以D1开口后的LAD病变3例(25.00%),两者之间有显著差异性(P<0.05)。前壁AMI伴有ST段I、avL导联抬高6例中,下壁ST段压低组和正常组分别为5例(83.33%)、1例(16.67%),两组之间有显著差异性(P<0.05)。结论:急性前壁心肌梗死合并下壁导联ST段压低与多支血管病变无关,而与LAD近端(D1之前)或LAD近端合并D1病变有关,可能反映高侧壁心肌缺血对应性改变
Objective: To investigate the clinical significance of ST segment depression in anterior wall acute myocardial infarction (AMI) combined with inferior leads. Methods: The electrocardiogram of 29 patients with AMI in the anterior wall was retrospectively analyzed. Coronary angiography was performed to evaluate the relationship between the infarction related lesion of the left anterior descending coronary artery (LAD) and the opening of the first diagonal branch (D1). Results: Among the 29 patients with AMI in the anterior wall and 12 cases with ST-segment depression in the inferior wall, 9 cases (75.00%) had LAD lesion before D1 opening or LAD complicated with D1 lesion, 3 cases had LAD lesion after D1 opening 25.00%), there was significant difference between the two (P <0.05). There were 5 cases (83.33%) and 1 case (16.67%) of AMI accompanied by ST segment I and 6 cases of elevation of AVL leads in ST segment depression group and normal group respectively. There was significant difference between the two groups (P <0.05). Conclusion: The ST-segment depression in acute anterior myocardial infarction with inferior leads is not related to multivessel disease, but is related to the proximal LAD (D1) or proximal LAD with D1, which may reflect the correspondence of high-sidewall myocardial ischemia change