标题：NSTEMI靶血管为左回旋支与右冠状动脉患者心电图特征的差异及意义

      作者：韩星 1，杨亚攀 2，申媛媛 3，范立华 4    1.河南中医药大学第三附属医院心电图室，河南 郑州 450000；2.阜外华中心血管病医院心血管内科，河南 郑州 450000；3.郑州人民医院心功能科，河南 郑州 450000；4.河南中医药大学第三附属医院心血管一病区，河南 郑州 450000

      卷次： 2024年35卷14期

      【摘要】 目的 探讨急性非ST段抬高型心肌梗死(NSTEMI)靶血管为左回旋支(LCX)与右冠状动脉(RCA)患者心电图特征的差异及意义。方法 选取2021年9月至2023年12月河南中医药大学第三附属医院收治的88例靶血管为LCX NSTEMI患者(LCX组)与70例靶血管为RCANSTEMI患者(RCA组)纳入研究。比较两组患者的一般资料及心电图特征，采用受试者工作特征曲线(ROC)分析心电图特征对靶血管定位的鉴别诊断价值。结果 两组患者的一般资料比较差异均无统计学意义(P>0.05)；RCA组患者STⅠ降低、STⅢ↑>STⅡ↑、(∑STV1~V3↓/∑STⅡ、Ⅲ、aVF↑)≤1、STV4R升高患者占比分别为 80.00%、92.86%、92.86%、45.71%，明显高于 LCX组的 26.14%、38.64%、51.14%、6.82%，ST Ⅰ等电线、ST Ⅱ↑>ST Ⅲ↑、STV4R降低、V7~V9导联QRS波终末扭曲患者占比分别为20.00%、5.71%、2.86%、5.71%，明显低于LCX组的70.45%、60.23%、31.82%、53.41%，差异均有统计学意义(P<0.05)；ROC分析结果显示，心电图各特征联合鉴别诊断LCX和RCA靶血管病变的曲线下面积(AUC)为 0.907 (95%CI：0.850~0.947)，其敏感度为94.25%，特异度为 87.14%，优于各特征单独鉴别诊断价值(P<0.05)。结论 心电图特征为ST Ⅰ降低、ST Ⅲ↑>ST Ⅱ↑、(∑STV1~V3↓/∑STⅡ、Ⅲ、aVF↑)≤1、STV4R升高对判断NSTEMI靶血管为RCA具有一定价值，STⅠ等电线、ST Ⅱ↑>ST Ⅲ↑、STV4R降低、V7~V9导联QRS波终末扭曲对判断NSTEMI靶血管为LCX具有一定价值，联合应用可作为临床鉴别诊断LCX与RCA靶血管的有效指标。
      【关键词】 非ST段抬高型心肌梗死；靶血管；左回旋支；右冠状动脉；心电图
      【中图分类号】 R542.2+2 【文献标识码】 A 【文章编号】 1003—6350（2024）14—2021—05

Difference and significance of electrocardiogram characteristics in patients of acute non-ST segment elevationmyocardial infarction with left circumflex coronary artery and right coronary artery as target vessels.
HAN Xing 1,YANG Ya-pan 2, SHEN Yuan-yuan 3, FAN Li-hua 4. 1. Department of Electrocardiography, the Third Affiliated Hospital ofHenan University of Traditional Chinese Medicine, Zhengzhou 450000, Henan, CHINA; 2. Department of Cardiology, FuwaiCentral China Cardiovascular Hospital, Zhengzhou 450000, Henan, CHINA; 3. Department of Cardiac Function, ZhengzhouPeople's Hospital, Zhengzhou 450000, Henan, CHINA; 4. Cardiovascular Ward 1, the Third Affiliated Hospital of HenanUniversity of Traditional Chinese Medicine, Zhengzhou 450000, Henan, CHINA
【Abstract】 Objective To investigate the differences and significance of electrocardiogram characteristics be-tween patients of acute non-ST segment elevation myocardial infarction (NSTEMI) with left circumflex coronary artery(LCX) and right coronary artery (RCA) as target vessels. Methods A total of 88 NSTEMI patients with LCX as targetvessels (LCX group) and 70 NSTEMI patients with RCA as target vessels (RCA group) were selected from the Third Af-filiated Hospital of Henan University of Chinese Medicine from September 2021 to December 2023. The general infor-mation and electrocardiogram characteristics of the two groups were compared, and the discriminatory diagnostic valueof electrocardiogram characteristics for target vessel localization was analyzed using receiver operating characteristic(ROC) curve. Results There was no statistically significant difference in general information between the two groupsof patients (P>0.05). The proportions of patients with decreased ST Ⅰ, ST Ⅲ↑>ST Ⅱ↑, (∑STV1-V3↓/∑STⅡ, Ⅲ,aVF↑)≤1, and increased STV4R in the RCA group (80.00%, 92.86%, 92.86%, 45.71%) were significantly higher thanthose in the LCX group (26.14%, 38.64%, 51.14%, 6.82%); the proportions of patients with STⅠ isoelectric line, STⅡ↑>ST Ⅲ↑, decreased STV4R, and QRS wave terminal distortion in leads V7-V9 (20.00%, 5.71%, 2.86%, 5.71%) were sig-nificantly lower than those in the LCX group (70.45%, 60.23%, 31.82%, 53.41%); the differences were statistically sig-nificant (P<0.05). ROC analysis showed that the area under the curve (AUC) of the combined use of various electrocar-diographic features for the differential diagnosis of LCX and RCA target vessel lesions was 0.907 (95%CI: 0.850-0.947),with a sensitivity of 94.25% and a specificity of 87.14%, which was superior to the value of each feature alone (P<0.05).Conclusion The electrocardiogram characteristics of ST Ⅰ decrease, ST Ⅲ↑>ST Ⅱ↑, (∑STV1-V3↓/∑STⅡ, Ⅲ,aVF↑)≤1, STV4R increase are valuable for identifying the target vessel of NSTEMI as the RCA. The ST Ⅰ isoelec-tric line, ST Ⅱ↑>ST Ⅲ↑, STV4R decrease, and QRS wave terminal distortion in leads V7-V9 are valuable for identify-ing the target vessel of NSTEMI as the LCX. The combined application can be used as an effective indicator for clinicaldifferential diagnosis of LCX and RCA target vessels.
      【Key words】 Non-ST segment elevation myocardial infarction; Target vessel; Left circumflex branch; Right coro-nary artery; Electrocardiogram