docﻲﻨﻴﻟﺎﺑ ﺖﻴﻤﻫا و عﻮﻴﺷ ﻪﻌﻄﻗ ﻦﺘﻓر ﻻﺎﺑ ST ﻲﻔﻠﺧ ﻲﻓاﺮﮔﻮﻳدرﺎﻛوﺮﺘﻜﻟا يﺎﻫﺪﻴﻟ رد
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ﻲﻨﻴﻟﺎﺑ ﺖﻴﻤﻫا و عﻮﻴﺷ ﻪﻌﻄﻗ ﻦﺘﻓر ﻻﺎﺑ ST ﻲﻔﻠﺧ ﻲﻓاﺮﮔﻮﻳدرﺎﻛوﺮﺘﻜﻟا يﺎﻫﺪﻴﻟ رد
ﻣﻘﺎﻟﻪ ﭘﮋوﻫﺸﻲ ﻣﺠﻠﻪ ﻋﻠﻤﻲ ﭘﮋوﻫﺸﻲ داﻧﺸﮕﺎه ﻋﻠﻮم ﭘﺰﺷﻜﻲ اراك ﺳﺎل ،12ﺷﻤﺎره ) 3ﺷﻤﺎره ﭘﻴﺎﭘﻲ ،(48ﭘﺎﻳﻴﺰ 23-28 ،1388 ﺷﻴﻮع و اﻫﻤﻴﺖ ﺑﺎﻟﻴﻨﻲ ﺑﺎﻻ رﻓﺘﻦ ﻗﻄﻌﻪ STدر ﻟﻴﺪﻫﺎي اﻟﻜﺘﺮوﻛﺎردﻳﻮﮔﺮاﻓﻲ ﺧﻠﻔﻲ در اﻧﻔﺎرﻛﺘﻮس ﺣﺎد ﻣﻴﻮﻛﺎرد ،ﺑﻴﻤﺎرﺳﺘﺎن ﺷﻬﻴﺪ رﺟﺎﻳﻲ ﺗﻬﺮان 1381 دﻛﺘﺮ وﻟﻲ اﻟﻪ ﺧﺪﻳﺮ ،*1دﻛﺘﺮﺳﻌﻴﺪ اورﻋﻲ 2 -1اﺳﺘﺎدﻳﺎر ،ﻣﺘﺨﺼﺺ ﻗﻠﺐ و ﻋﺮوق ،ﮔﺮوه ﻗﻠﺐ و ﻋﺮوق ،داﻧﺸﮕﺎه ﻋﻠﻮم ﭘﺰﺷﻜﻲ اراك ،اراك ،اﻳﺮان D -2ﻓﻮق ﺗﺨﺼﺺ اﻟﻜﺘﺮوﻓﻴﺰﻳﻮﻟﻮژي ،ﺑﻴﻤﺎرﺳﺘﺎن دي ،ﺗﻬﺮان ،اﻳﺮان SI ﭼﻜﻴﺪه ﺗﺎرﻳﺦ درﻳﺎﻓﺖ ، 88/2/6ﺗﺎرﻳﺦ ﭘﺬﻳﺮش 88/6/11 of ﻣﻘﺪﻣﻪ :ﻣﻌﻴﺎرﻫﺎي ﻓﻌﻠﻲ اﻟﻜﺘﺮوﻛﺎردﻳﻮﮔﺮاﻓﻲ ﺑﺮاي ﺗﺸﺨﻴﺺ اﻧﻔﺎرﻛﺘﻮس ﺧﻠﻔﻲ ﻗﻠﺐ ﻏﻴـﺮ ﺣـﺴﺎس ﻣـﻲﺑﺎﺷـﺪ و اﻛﺜﺮﻳـﺖ اﻳـﻦ ﺑﻴﻤﺎران ﺗﺸﺨﻴﺺ داده ﻧﻤﻲﺷﻮﻧﺪ .ﻫﺪف از اﻳﻦ ﻣﻄﺎﻟﻌﻪ ارزﻳﺎﺑﻲ ﺷﻴﻮع و اﻫﻤﻴﺖ ﺑﺎﻟﻴﻨﻲ ﺑﺎﻻ رﻓﺘﻦ ﻗﻄﻌﻪ STدر ﻟﻴـﺪﻫﺎي ﺧﻠﻔـﻲ ﻗﻠﺐ در ﺑﻴﻦ ﺑﻴﻤﺎران ﺑﺎ ﺗﺸﺨﻴﺺ اﻧﻔﺎرﻛﺘﻮس ﺣﺎد ﻣﻴﻮﻛﺎرد ﻣﻲ ﺑﺎﺷﺪ. روش ﻛﺎر :در ﻃﻲ ﻳﻚ ﻣﻄﺎﻟﻌﻪ ﻣﻘﻄﻌﻲ – ﺗﺤﻠﻴﻠﻲ در 210ﺑﻴﻤﺎر ﻣﺘﻮاﻟﻲ ﭘﺬﻳﺮش ﺷﺪه ﺑﺎ ﺗﺸﺨﻴﺺ اﻧﻔﺎرﻛﺘﻮس ﺣـﺎد ﻣﻴﻮﻛـﺎرد در ﺑﺨﺶ ﻣﺮاﻗﺒﺖﻫﺎي وﻳﮋه ﺑﻴﻤﺎرﺳﺘﺎن ﺷﻬﻴﺪ رﺟﺎﺋﻲ ،ﺑﻼﻓﺎﺻﻠﻪ ﻟﻴﺪﻫﺎي اﻟﻜﺘﺮوي ﺧﻠﻔﻲ) (V7,V8 and V9ﺑﻪ ﻣـﻮازات 12 ﻟﻴﺪ اﺳﺘﺎﻧﺪارد ﺛﺒﺖ ﺷﺪ .اﻧﻔﺎرﻛﺘﻮس ﻣﺠﺪد ،آرﻳﺘﻤﻲﻫﺎي ﻣﺪاوم ،اﻓﺖ ﻓﺸﺎر ﺧﻮن ،ﺷﻮك ﻛﺎردﻳﻮژﻧﻴﻚ ،ﻧﺎرﺳﺎﻳﻲ ﻗﻠﺒﻲ ﻋﻼﻣـﺖ دار و ﻳﺎ ادم ﺣﺎد رﻳﻪ ﺑﻪ ﻋﻨﻮان ﻋﻮارض داﺧﻞ ﺑﻴﻤﺎرﺳﺘﺎﻧﻲ در ﻧﻈﺮ ﮔﺮﻓﺘﻪ ﺷﺪﻧﺪ .ﭘﺎراﻣﺘﺮﻫﺎي ﻣﺮﺗﺒﻂ ﺑﺎ ﻣﺸﺨـﺼﺎت زﻣﻴﻨـﻪاي و ﺳـﻴﺮ ﺑﻌﺪي ﺑﻴﻤﺎران در دو ﮔﺮوه ﺑﻴﻤﺎران ﺑﺎ و ﺑﺪون ﺑﺎﻻ رﻓﺘﻦ ﻗﻄﻌﻪ STدر ﻟﻴﺪﻫﺎي ﺧﻠﻔﻲ ﻣﻘﺎﻳﺴﻪ ﺷﺪﻧﺪ. ﻧﺘﺎﻳﺞ 153 :ﺑﻴﻤﺎر ﺑﺎﻻ رﻓﺘﻦ ﻗﻄﻌﻪ ST≥1ﻣﻴﻠﻲ ﻟﻴﺘﺮ را در دو ﻟﻴﺪ ﻣﺠـﺎور ﻳـﺎ ﺑﻴـﺸﺘﺮ داﺷـﺘﻨﺪ12/4 .درﺻـﺪ ﺑﻴﻤـﺎران ST≥1 ﻣﻴﻠﻲ ﻣﺘﺮ در 2ﻟﻴﺪ ﺧﻠﻔﻲ داﺷﺘﻨﺪ ﻛﻪ ﻳﺎ ﺑﻪ ﺗﻨﻬﺎﻳﻲ ) 4/6درﺻﺪ( و ﻳﺎ ﻫﻤﺮاه ﺑﺎ ﺗﻐﻴﻴﺮات در ﻟﻴﺪﻫﺎي ﺗﺤﺘﺎﻧﻲ ﻳﺎ ﺧﺎرﺟﻲ ﻗﻠـﺐ )7/8 درﺻﺪ( ﺑﻮد .اﻟﻜﺘﺮوي 12ﻟﻴﺪ اﺳﺘﺎﻧﺪارد در 2ﺑﻴﻤﺎر ﻧﺮﻣﺎل ﺑﻮد و 5ﺑﻴﻤﺎر دﻳﮕﺮ ﺑﺎ ﺗﺸﺨﻴﺺ اﻧﻔﺎرﻛﺘﻮس ﺑـﺪون ﻣـﻮج Qﺑـﺴﺘﺮي ﺷﺪﻧﺪ .ﻣﻮج Rﺑﻠﻨﺪ در V1/V2در 26/3درﺻﺪ ﺑﻴﻤﺎران اﻳﺠﺎد ﺷﺪ .ﻋﻮارض داﺧـﻞ ﺑﻴﻤﺎرﺳـﺘﺎﻧﻲ در ﺑﻴﻤـﺎران ﺑـﺎ ﺗﻐﻴﻴـﺮات در ﻟﻴﺪﻫﺎي ﺧﻠﻔﻲ ﺷﺎﻳﻊﺗﺮ ﺑﻮد ) 47/3درﺻﺪ در ﻣﻘﺎﺑﻞ 20/9درﺻﺪ.(p=0/01 ، ﻧﺘﻴﺠﻪ ﮔﻴﺮي :ﺗﻐﻴﻴﺮات در ﻟﻴﺪﻫﺎي ﺧﻠﻔﻲ در اﻧﻔﺎرﻛﺘﻮس ﺣﺎد ﻗﻠﺒﻲ ﻧﺎﺷﺎﻳﻊ ﻧﻴﺴﺖ و ﻣﻤﻜﻦ اﺳﺖ ﻧـﺸﺎﻧﻪ ﺳـﻴﺮ ﺑـﺪ ﺑﻴﻤﺎرﺳـﺘﺎﻧﻲ ﺑﺎﺷﺪ. واژﮔﺎن ﻛﻠﻴﺪي :اﻟﻜﺘﺮوﻛﺎردﻳﻮﮔﺮاﻓﻲ ،اﻧﻔﺎرﻛﺘﻮس ﻣﻴﻮﻛﺎرد ،ﭘﻴﺶ آﮔﻬﻲ ive ch Ar * ﻧﻮﻳﺴﻨﺪه ﻣﺴﺌﻮل :اراك ،ﺑﻴﻤﺎرﺳﺘﺎن اﻣﻴﺮﻛﺒﻴﺮ Email: [email protected] 23 www.SID.ir ﺷﻴﻮع و اﻫﻤﻴﺖ ﺑﺎﻟﻴﻨﻲ ﺑﺎﻻ رﻓﺘﻦ ﻗﻄﻌﻪ STدر ﻟﻴﺪﻫﺎي ... دﻛﺘﺮ وﻟﻲ اﻟﻪ ﺧﺪﻳﺮ و ﻫﻤﻜﺎران آﻧــﺰﻳﻢﻫــﺎي ﻗﻠﺒــﻲ ﺑــﺪون STEﻳــﺎ ﻣــﻮج Qدر ﻫــﺮ ﻛــﺪام از ﻣﻘﺪﻣﻪ در ﻃﻲ دﻫﻪ ﻫﺎي اﺧﻴﺮ درﻣﺎن ﺗﺮوﻣﺒﻮﻟﻴﺘﻴـﻚ ،ﻣﻴـﺰان ﻟﻴﺪﻫﺎي ﻗﻠﺒﻲ ﺑﻮد .ﺗﻤﺎم ﺑﻴﻤﺎران ﺑﺪون دﺧﺎﻟﺖ ﻣﻄﺎﻟﻌﻪ ﻛﻨﻨﺪﮔﺎن ﻣﺮگ ﻧﺎﺷﻲ از اﻧﻔﺎرﻛﺘﻮس ﺣﺎد ﻗﻠﺒﻲ (Acute Myocardial ﺗﻮﺳﻂ ﻣﺘﺨﺼﺼﺎن ﻣﺴﻮول درﻣـﺎن ﺷـﺪﻧﺪ و در ﺧـﻼل ﺑـﺴﺘﺮي ) Infarction- AMIرا ﺑﻪ ﻃـﻮر ﻗﺎﺑـﻞ ﺗـﻮﺟﻬﻲ ﻛـﺎﻫﺶ داده ﭘﻲﮔﻴﺮي ﺷﺪﻧﺪ. روش درﻣﺎن ﻣﻲﺑﺎﺷﻨﺪ) .(4در ﺣﺎل ﺣﺎﺿـﺮ ﺑـﺮاي ﺑﻴﻤـﺎراﻧﻲ ﻛـﻪ ﺳﻦ ) ≥ 45ﺳـﺎل در ﻣـﺮدان و ≥55ﺳـﺎل در زﻧـﺎن( ،ﻣـﺼﺮف اﻓﺰاﻳﺶ ﻗﻄﻌﻪ (ST Elevation )STدر ﻟﻴﺪﻫﺎي اﺳﺘﺎﻧﺪارد را ﻓﻌﻠـﻲ ﺳـﻴﮕﺎر ،ﻫﻴﭙﺮﻛﻠـﺴﺘﺮوﻣﻲ)serum LDL level ≥130 ﻧﺪارﻧﺪ اﻳﻦ روش درﻣﺎﻧﻲ ﺗﻮﺻـﻴﻪ ﻧﻤـﻲﺷـﻮد) ،(5درﺣـﺎﻟﻲ ﻛـﻪ ﻣﻴﻠﻲ ﮔﺮم در دﺳـﻲ ﻟﻴﺘـﺮ( ،ﺳـﻄﺢ ﺳـﺮﻣﻲ ﭘـﺎﻳﻴﻦ <35) HDL ﺑﻌﻀﻲ از اﻳﻦ ﺑﻴﻤﺎران ﻣﻤﻜﻦ اﺳﺖ دﭼـﺎر اﻧﻔـﺎرﻛﺘﻮس ﺗـﺮاﻧﺲ ﻣﻴﻠﻲ ﮔﺮم در دﺳﻲ ﻟﻴﺘﺮ( ،ﻫﻴﭙﺮﺗﺎﻧﺴﻴﻮن ،دﻳﺎﺑﺖ ﺷﻴﺮﻳﻦ و ﺳـﺎﺑﻘﻪ ﻣــــــﻮرال )ﻫﻤــــــﺮاه ﻣــــــﻮج (Qدر ﻧــــــﻮاﺣﻲ ﺧــــــﺎﻣﻮش ﺧﺎﻧﻮادﮔﻲ از ﺑﻴﻤﺎري ﻋﺮوق ﻛﺮوﻧﺮ زودرس ﺑﻮد. D اﺳﺖ) .(1-3ﺑﺎ اﻳﻦ ﺣﺎل ﺗﻌﺪاد ﻣﻮارد ﻛﻤـﻲ ﻣﻨﺎﺳـﺐ ﺑـﺮاي اﻳـﻦ ﻓﺎﻛﺘﻮرﻫﺎي ﺧﻄﺮ ﻗﻠﺒﻲ و ﻋﺮوﻗـﻲ ﺛﺒـﺖ ﺷـﺪه ﺷـﺎﻣﻞ SI اﻟﻜﺘﺮوﻛﺎردﻳﻮﮔﺮاﻓﻴـــﻚ ﺷـــﻮﻧﺪ ﻛـــﻪ ﺑـــﺎ ﻟﻴـــﺪﻫﺎي اﻟﻜﺘـــﺮوي اﺳﺘﺎﻧﺪارد ﺗﺸﺨﻴﺺ داده ﻧﺸﻮﻧﺪ) .(6اﻧﻔﺎرﻛﺘﻮس ﻧﺎﺣﻴﻪ ﺧﻠﻔﻲ از ﻧﻮاﺣﻲ اﺳﺖ ﻛﻪ ﺑﺎ ﻣﺮگ و ﻣﻴـﺮ ﺑـﺎﻻ ﻫﻤـﺮاه اﺳـﺖ) .(7ﺑـﺎ ﺑﻬـﺮه اﻧﻔﺎرﻛﺘﻮس ﻣﺠﺪد،آرﻳﺘﻤﻲ ﻫﺎي ﻣﺪاوم ،اﻓـﺖ ﻓـﺸﺎر ﺧﻮن ،ﺷﻮك ﻛﺎردﻳﻮژﻧﻴﻚ ،ﻧﺎرﺳﺎﻳﻲ ﻗﻠﺒـﻲ ﻋﻼﻣـﺖ دار و ﻳـﺎ ادم ﺣـﺎد رﻳــﻪ ﺑـﻪ ﻋﻨــﻮان ﻋــﻮارض داﺧـﻞ ﺑﻴﻤﺎرﺳــﺘﺎﻧﻲ در ﻧﻈــﺮ ﻧــﻮع از اﻧﻔــﺎرﻛﺘﻮس را اﻓــﺰاﻳﺶ داد) .(8اﻳــﻦ ﻣﻄﺎﻟﻌــﻪ اوﻟﻴــﻪ در ﺑﻌــﺪي ﺑﻴﻤــﺎران در دو ﮔــﺮوه ﺑﻴﻤــﺎران ﺑــﺎ و ﺑــﺪون STEدر ﺟﻬﺖ ارزﻳﺎﺑﻲ ﺷﻴﻮع و اﻫﻤﻴﺖ ﺑﺎﻟﻴﻨﻲ STEدر ﻟﻴﺪﻫﺎي ﺧﻠﻔﻲ ﻟﻴﺪﻫﺎي ﺧﻠﻔﻲ ﻣﻘﺎﻳﺴﻪ ﺷﺪﻧﺪ. of ﺟﻮﻳﻲ از ﻟﻴﺪﻫﺎي ﺧﻠﻔﻲ ﻗﻠﺐ ﻣـﻲﺗـﻮان ﻗـﺪرت ﺗـﺸﺨﻴﺺ اﻳـﻦ ﮔﺮﻓﺘﻪ ﺷﺪﻧﺪ .ﭘﺎراﻣﺘﺮﻫﺎي ﻣﺮﺗﺒﻂ ﺑﺎ ﻣﺸﺨﺼﺎت زﻣﻴﻨـﻪاي و ﺳـﻴﺮ ﻗﻠﺐ در ﺑﻴﻦ ﺑﻴﻤﺎران ﭘـﺬﻳﺮش ﺷـﺪه ﺑﺎﺗـﺸﺨﻴﺺ AMIﺻـﻮرت ive ﮔﺮﻓﺖ. ﺑﺎ ﺗﻮﺟﻪ ﺑﻪ اﻳﻦ ﻛﻪ در ﺑﺮرﺳـﻲ ﺑﻴﻤـﺎران اﺳـﺎﻣﻲ آﻧﻬـﺎ ﻓــﺎش ﻧــﺸﺪه و ﻫــﻢﭼﻨــﻴﻦ ﺗــﺪاﺧﻞ درﻣــﺎﻧﻲ ﺻــﻮرت ﻧﮕﺮﻓﺘــﻪ و روش ﻛﺎر ﻛﻪ ﺑﺎ ﺗﺸﺨﻴﺺ AMIاز اردﻳﺒﻬـﺸﺖ ﺗـﺎ ﺷﻬﺮﻳﻮرﺳـﺎل 1381در ﺑﺨﺶ ﻣﺮاﻗﺒﺖﻫﺎي وﻳﮋه ﺑﻴﻤﺎرﺳﺘﺎن ﺷﻬﻴﺪ رﺟﺎﻳﻲ ﺑﺴﺘﺮي ﺷﺪﻧﺪ ﻫﺰﻳﻨﻪاي از اﻳﻦ ﺑﺎﺑﺖ ﺑﺮ ﺑﻴﻤﺎر ﺗﺤﻤﻴﻞ ﻧﺸﺪه اﺳﺖ .ﻛﻠﻴﻪ ﻣﻮازﻳﻦ اﺧﻼق در ﭘﮋوﻫﺶ رﻋﺎﻳﺖ ﮔﺮدﻳﺪ. ﻧﺘﺎﻳﺞ ch در ﻳﻚ ﻣﻄﺎﻟﻌﻪ ﻣﻘﻌﻄﻲ -ﺗﺤﻠﻴﻠﻲ 210ﺑﻴﻤـﺎر ﻣﺘـﻮاﻟﻲ ﺻﺮﻓﺎ در ﻧﺤﻮه اﺧﺬ ﻧـﻮار ﻗﻠـﺐ اوﻟﻴـﻪ ﺗﻔـﺎوت وﺟـﻮد داﺷـﺘﻪ و راه ﻓﺮﻋــﻲ و اﺧــﺘﻼل ﻫﻤﻮدﻳﻨﺎﻣﻴــﻚ ﺑﻮدﻧــﺪ از ﻣﻄﺎﻟﻌــﻪ ﺣــﺬف ﻛﺪام از ﻟﻴﺪﻫﺎ STEﻧﺪاﺷﺘﻨﺪ .ﻣﺤﻞﻫﺎي اﻧﻔﺎرﻛﺘﻮس STEدر ﺷﺪﻧﺪ 12.ﻟﻴﺪ اﺳﺘﺎﻧﺪارد اﻟﻜﺘﺮو ﻫﻤﺮاه ﺑﺎ ﻟﻴﺪﻫﺎي ﺳﻄﺢ ﺧﻠﻔﻲ و 153ﺑﻴﻤﺎر) 72/8درﺻﺪ( دﻳﮕﺮ در ﺟﺪول 1ﻟﻴﺴﺖ ﺷﺪه اﺳﺖ. Ar ﻣﻮرد ﻣﻄﺎﻟﻌﻪ ﻗﺮار ﮔﺮﻓﺘﻨﺪ .اﻓﺮادي ﻛﻪ دﭼﺎر ﺑﻠـﻮك ﺷـﺎﺧﻪاي، در 57ﺑﻴﻤـﺎر) 27/1درﺻــﺪ از 210ﻣـﻮرد( در ﻫــﻴﭻ ﺳﻤﺖ راﺳـﺖ ﻗﻠـﺐ ﺑﻼﻓﺎﺻـﻠﻪ ﭘـﺲ از ﭘـﺬﻳﺮش ﺗﻤـﺎم ﺑﻴﻤـﺎران ﺟﺪول .1ﻣﺤﻠﻬﺎي اﻧﻔﺎرﻛﺘﻮس ﺑﺎﻻ رﻓﺘﻦ ﻗﻄﻌﻪ STﺑﺮاﺳﺎس ﺗﻐﻴﻴﺮات ﮔﺮﻓﺘﻪ ﺷﺪ .ﻟﻴﺪﻫﺎي ﺧﻠﻔﻲ ﻗﻠﺐ ﺑﺎ ﮔﺬاﺷﺘﻦ ﻟﻴـﺪﻫﺎي اﻟﻜﺘـﺮو در اﻟﻜﺘﺮوﻛﺎردﻳﻮﮔﺮاﻓﻴﻚ در 153ﺑﻴﻤﺎر ﺑﺴﺘﺮي در ﺑﻴﻤﺎرﺳﺘﺎن ﺷﻬﻴﺪ رﺟﺎﺋﻲ ﻓﻀﺎﻫﺎي ﺑﻴﻦ دﻧﺪهاي ﭘﻨﺠﻢ در ﺧﻂ ﺧﻠﻔﻲ آﮔﺰﻳﻼري ) (V7و ﺗﻬﺮان 1381 در ﺧــﻂ وﺳــﻂ ﻛﺘــﻒ ) (V8و ﻣﺠــﺎور ﺳــﺘﻮن ﻓﻘــﺮات )(V9 ﮔﺮﻓﺘــﻪ ﺷــﺪ .ﺗــﺸﺨﻴﺺ AMIﺑﺮاﺳــﺎس ﻣﻌﻴﺎرﻫــﺎي ﺳــﺎزﻣﺎن ﺑﻬﺪاﺷﺖ ﺟﻬﺎﻧﻲ داده ﺷﺪ .اﻧﻔﺎرﻛﺘﻮس ﻣﻴﻮﻛﺎرد ﺑﺪون ﻣﻮج Q زﻣﺎﻧﻲ در ﻧﻈـﺮ ﮔﺮﻓﺘـﻪ ﺷـﺪ ﻛـﻪ درد ﺳـﻴﻨﻪ ﻃـﻮﻻﻧﻲ و اﻓـﺰاﻳﺶ ﻣﺠﻠﻪ ﻋﻠﻤﻲ ﭘﮋوﻫﺸﻲ داﻧﺸﮕﺎه ﻋﻠﻮم ﭘﺰﺷﻜﻲ اراك ،ﺳﺎل دوازدﻫﻢ ،ﺷﻤﺎره ،3ﭘﺎﻳﻴﺰ 1388 www.SID.ir ﺗﻌﺪاد )درﺻﺪ( ﻣﺤﻞ (41/2)63 (43/1)66 (12/4)19 (20/9)32 (14/4)22 ﻗﺪاﻣﻲ ﺗﺤﺘﺎﻧﻲ ﺧﻠﻔﻲ ﺧﺎرﺟﻲ ﭘﺮه ﻛﻮردﻳﺎل راﺳﺖ 24 ﺷﻴﻮع و اﻫﻤﻴﺖ ﺑﺎﻟﻴﻨﻲ ﺑﺎﻻ رﻓﺘﻦ ﻗﻄﻌﻪ STدر ﻟﻴﺪﻫﺎي ... STEدر 19ﺑﻴﻤﺎر ) 12/4درﺻﺪ( از 153ﻣـﻮرد ﻳـﺎ دﻛﺘﺮ وﻟﻲ اﻟﻪ ﺧﺪﻳﺮ و ﻫﻤﻜﺎران ﺑﺤﺚ ﺳﻄﻮح ﺗﺤﺘﺎﻧﻲ ﻳـﺎ ﺧـﺎرﺟﻲ در 12ﻣـﻮرد ) 7/8درﺻـﺪ( دﻳـﺪه ﺧﺎﻣﻮش اﻟﻜﺘﺮوﻛﺎردﻳﻮﮔﺮاﻓﻴﮓ ﻗﻠﺐ ﻣﻲﺑﺎﺷﺪ .ﻣﻌﻴﺎرﻫﺎي ﻓﻌﻠﻲ ﺷﺪ .اﻟﻜﺘﺮوي اﺳﺘﺎﻧﺪارد 12ﻟﻴﺪ در دو ﺑﻴﻤﺎر ﻛﺎﻣﻼ ﻧﺮﻣﺎل ﺑﻮد و اﻟﻜﺘﺮوﻛﺎردﻳﻮﮔﺮاﻓﻲ ﺑﺮاي ﺗﺸﺨﻴﺺ اﻧﻔـﺎرﻛﺘﻮس ﺧﻠﻔـﻲ ﻗﻠـﺐ 5ﺑﻴﻤﺎر دﻳﮕﺮ ﺑﺎ ﺗﺸﺨﻴﺺ اﻧﻔـﺎرﻛﺘﻮس ﺑـﺪون ﻣـﻮج Qﺑـﺴﺘﺮي ﻏﻴﺮ ﺣﺴﺎس ﻣﻲﺑﺎﺷـﺪ و اﻛﺜﺮﻳـﺖ اﻳـﻦ ﺑﻴﻤـﺎران ﺗـﺸﺨﻴﺺ داده ﺷﺪﻧﺪ .ﻣﻮج Rﺑﻠﻨﺪ در ﻟﻴﺪ V1و ﻳﺎ V2در 5ﺑﻴﻤﺎر اﻳﺠﺎد ﺷـﺪ ﻧﻤﻲ ﺷـﻮﻧﺪ) .(11 ،10ﺷـﺎه و ﻫﻤﻜـﺎران ﮔـﺰارش ﻛﺮدﻧـﺪ ﻛـﻪ ﺑـﺎ ) 26/3درﺻــﺪ از 19ﺑﻴﻤــﺎر( .اﺧــﺘﻼل ﺣﺮﻛــﺎت دﻳــﻮارهاي در اﻧــﺴﺪاد ﻛﺎﻣــﻞ ﺳــﺮﺧﺮگ ﭼﺮﺧــﺸﻲ ﭼــﭗ ﻗﻠــﺐ در ﺧــﻼل ﻧﺎﺣﻴﻪ ﺧﻠﻔﻲ در ﺗﻤﺎﻣﻲ اﻳﻦ ﺑﻴﻤﺎران ﺑﻪ روش اﻛﻮﻛﺎردﻳﻮﮔﺮاﻓﻲ آﻧﮋﻳﻮﭘﻼﺳﺘﻲ STE ≥1 ،ﻣﻴﻠﻲ ﻣﺘـﺮ در ﻟﻴـﺪﻫﺎي اﺳـﺘﺎﻧﺪارد در ﺛﺒﺖ ﺷﺪ .اﺳﻜﻦ ﺗﻜﻨﺴﻴﻮم ﭘﻴﺮوﻓـﺴﻔﺎت ﺑـﻪ روش اﺳـﭙﻜﺖ -48 35درﺻــــﺪ ﺑﻴﻤــــﺎران و ﭘــــﺎﻳﻴﻦ رﻓــــﺘﻦ ﻗﻄﻌــــﻪST 24ﺳﺎﻋﺖ ﺑﻌﺪ از ﭘﺬﻳﺮش ﻣﻄﺮح ﻛﻨﻨﺪه اﻧﻔﺎرﻛﺘﻮس ﺧﻠﻔـﻲ در ) Depressionدر 35درﺻﺪ دﻳﮕﺮ رخ داد ،در ﺣﺎﻟﻲ ﻛـﻪ در ﺗﻤﺎﻣﻲ ﺑﻴﻤﺎران ﺑﺎ STEدر ﻟﻴـﺪﻫﺎي ﺧﻠﻔـﻲ ﺑـﻪ ﻏﻴـﺮ از 2ﺑﻴﻤـﺎر 30درﺻﺪ ﺑﻴﻤﺎران ﺗﻐﻴﻴـﺮات STدﻳـﺪه ﻧـﺸﺪ) .(12اﻛﺜـﺮ ﻣـﻮارد D ﺑﻪ ﻃﻮر اﻳﺰوﻟﻪ در 7ﻣﻮرد ) 4/6درﺻﺪ( ﻳـﺎ ﻫﻤـﺮاه ﺑـﺎ STEدر ﻣﻴﻮﻛﺎرد ﺳﻄﺢ ﺧﻠﻔـﻲ ﺑﻄـﻦ ﭼـﭗ ﻳﻜـﻲ از ﻧـﻮاﺣﻲ SI ﺑﻮد. ﺟﺪول 2ﻣﺸﺨﺼﺎت ﺑﺎﻟﻴﻨﻲ و دﻣﻮﮔﺮاﻓﻴﻚ ﺑﻴﻤـﺎران (ST اﻧﻔﺎرﻛﺘﻮس ﺧﻠﻔﻲ آﺷﻜﺎرا ﻫﻤـﺮاه ﺑـﺎ اﻧﻔـﺎرﻛﺘﻮسﻫـﺎي ﺳـﻄﺢ ﺗﺤﺘﺎﻧﻲ ﻳﺎ ﺧﺎرﺟﻲ ﻣﻲﺑﺎﺷﺪ).(13 اﮔــﺮ ﭼــﻪ ﻫﻨــﻮز ﻣــﻮرد ﺑﺤــﺚ اﺳــﺖ ،ﺷــﻮاﻫﺪ ﻗﺎﺑــﻞ of را ﺑﺮاﺳـﺎس وﺟـﻮد ﻳـﺎ ﻋـﺪم وﺟـﻮد STEدر ﻟﻴـﺪﻫﺎي ﺧﻠﻔـﻲ ﺗــﻮﺟﻬﻲ وﺟــﻮد دارد ﻛــﻪ ST DEPدر ﺧــﻼل اﻧﻔــﺎرﻛﺘﻮس ﺧﻼﺻﻪ ﻛﺮده اﺳﺖ. ﺗﺤﺘـﺎﻧﻲ ﻣﻮﻳــﺪ ﮔﺮﻓﺘـﺎري ﺳــﻄﺢ ﺧﻠﻔـﻲ -ﺧــﺎرﺟﻲ ﺑﻄـﻦ ﭼــﭗ ﺟﺪول . 2ﻣﺸﺨﺼﺎت ﺑﻴﻤﺎران ﺑﺎ ﻳﺎ ﺑﺪون ﺑﺎﻻ رﻓﺘﻦ ﻗﻄﻌﻪ (STE) STدر 1381 ﺑﺰرﮔــﻲ از ﺑﻴﻤــﺎران ﺑــﺎ اﻧﻔــﺎرﻛﺘﻮس ﺗﺤﺘــﺎﻧﻲ STDEP ،ﺑــﺎ p ﮔﺮﻓﺘﺎري ﭼﻨﺪ رگ ﻳﺎ ﮔﺮﻓﺘﺎري ﻫﻤﺰﻣﺎن ﺷﺎﺧﻪ ﻛﺮوﻧﺮي ﭼـﭗ ﻫﻤﺮاه ﻧﺒﻮد) ،(18اﻣﺎ ارﺗﺒﺎط آن ﺑﺎ ﮔﺮﻓﺘـﺎري ﺷـﺎﺧﻪﻫـﺎي ﺗﻐﺬﻳـﻪ ﺑﺎ STEدر ﺑﺪون STEدر ﻟﻴﺪﻫﺎي ﺧﻠﻔﻲ ﻟﻴﺪﻫﺎي ﺧﻠﻔﻲ 68/4 67/9 96/0 (7/3)64/4 (9/0)57/2 0/001 (1/1)3/4 (1/1)2/5 0/002 (10/5) 2 (38/1) 51 0/01 (47/4) 9 (38/1)51 0/43 ﻣﻲﺑﺎﺷﺪ .اﻳﻦ ﺑﻴﻤﺎران ﻣﻤﻜﻦ اﺳﺖ اﻟﻜﺘـﺮوي اﺳـﺘﺎﻧﺪارد ﻧﺮﻣـﺎل (47/3)9 (20/9)28 0/01 داﺷﺘﻪ ﻳﺎ ﺑﻪ ﺻﻮرت اﻧﻔﺎرﻛﺘﻮس ﺑﺪون ﻣﻮج Qﺗﻈﺎﻫﺮ ﻛﻨﻨﺪ)،10 (26/3)5 (11/2)15 0/07 ch ﻛﻨﻨﺪه ﺳﻄﺢ ﺧﻠﻔﻲ -ﺧﺎرﺟﻲ ﺑﻄﻦ ﭼـﭗ ﻛﺮوﻧـﺮ راﺳـﺖ ﻧـﺸﺎن داده ﺷــﺪ) .(19در ﺣــﺎل ﺣﺎﺿــﺮ ﺣﺘــﻲ ﺑــﺎ ﺑﻬﺘــﺮﻳﻦ روشﻫــﺎي درﻣﺎﻧﻲ ،ﻣﻴﺰان ﻣﺮگ اﻳﻦ ﺑﻴﻤﺎران ﺑﻪ ﻣﻴﺰان آن در اﻧﻔـﺎرﻛﺘﻮس ﻗﺪاﻣﻲ ﻣﻲرﺳﺪ) .(20ﻓﺮض ﺷﺪه ﻛﻪ ﻣﻴﺰان ﻣﺮگ ﺑﻪ ﻃﻮر ﺧﻄﻲ Ar ﺟﻨﺲ ﻣﺬﻛﺮ )درﺻﺪ( ﺳﻦ ﻣﻴﺎﻧﮕﻴﻦ )اﻧﺤﺮاف ﻣﻌﻴﺎر( ﻓﺎﻛﺘﻮرﻫﺎي ﺧﻄﺮ ﻣﻴﺎﻧﮕﻴﻦ )اﻧﺤﺮاف ﻣﻌﻴﺎر( درﻣﺎن ﺑﺎ ﺗﺮوﻣﺒﻮﻟﻴﺘﻴﻚ ﺗﻌﺪاد )درﺻﺪ( ﻧﺎرﺳﺎﻳﻲ ﺑﻄﻦ ﭼﭗ ﺗﻌﺪاد )درﺻﺪ( ﻋﻮارض داﺧﻞ ﺑﻴﻤﺎرﺳﺘﺎﻧﻲ ﺗﻌﺪاد )درﺻﺪ( ﻣﺮگ ﺗﻌﺪاد )درﺻﺪ( ive ﻟﻴﺪﻫﺎي ﺧﻠﻔﻲ اﻟﻜﺘﺮوﻛﺎردﻳﻮﮔﺮاﻓﻲ در ﺑﻴﻤﺎرﺳﺘﺎن ﺷﻬﻴﺪ رﺟﺎﺋﻲ ﺗﻬﺮان ﻣﻲﺑﺎﺷﺪ) .(14-17در ﮔﺰارﺷﻲ از ﻣﺤﻘﻘﺎن ﮔﻮﺳـﺘﻮ در ﺟﻤﻌﻴـﺖ ﺑﺎ اﻓﺰاﻳﺶ ﻣﻴﺰان ST DEPاﻓﺰاﻳﺶ ﻣﻲﻳﺎﺑﺪ) (21و ﻣﻲﺗـﻮان ﺑـﺎ ﺗﺠﻮﻳﺰ ﺑﻪ ﻣﻮﻗﻊ ﺗﺮوﻣﺒﻮﻟﻴﺘﻴﻚ آن را ﻛﺎﻫﺶ داد).(22 ﺗــﺸﺨﻴﺺ اﻧﻔــﺎرﻛﺘﻮس ﺧﻠﻔــﻲ اﻳﺰوﻟــﻪ ﻣــﺸﻜﻞﺗــﺮ .(11ﻣﻤﻜﻦ اﺳﺖ ﺛﺎﺑﺖ ﺷﻮد ﻛﻪ اﻓﺰودن ﻟﻴـﺪﻫﺎي ﺧﻠﻔـﻲ روش ﺑﺎ ارزﺷﻲ در ﺗﺸﺨﻴﺺ اﻳﻦ ﻣﻮارد ﺑﺎﺷﺪ .ﻧﺸﺎن داده ﺷﺪه ﻛﻪ اﻳﻦ روش ﺣﺴﺎﺳﻴﺖ ﺗﺸﺨﻴﺺ اﻧﻔﺎرﻛﺘﻮس را اﻓﺰاﻳﺶ ﻣﻲدﻫﺪ).(23 در ﮔﺮوه ﻣﻮرد ﻣﻄﺎﻟﻌﻪ ﻣﺎ 19 ،ﺑﻴﻤﺎر STEدر ﻟﻴـﺪﻫﺎي ﺧﻠﻔـﻲ و ﻣﺠﻠﻪ ﻋﻠﻤﻲ ﭘﮋوﻫﺸﻲ داﻧﺸﮕﺎه ﻋﻠﻮم ﭘﺰﺷﻜﻲ اراك ،ﺳﺎل دوازدﻫﻢ ،ﺷﻤﺎره ،3ﭘﺎﻳﻴﺰ 1388 www.SID.ir 25 ... در ﻟﻴﺪﻫﺎيST ﺷﻴﻮع و اﻫﻤﻴﺖ ﺑﺎﻟﻴﻨﻲ ﺑﺎﻻ رﻓﺘﻦ ﻗﻄﻌﻪ ﻳﺎ ﺷﻮاﻫﺪ دﻳﮕـﺮ اﻧﻔـﺎرﻛﺘﻮس ﺧﻠﻔـﻲ را داﺷـﺘﻨﺪ در ﺣـﺎﻟﻲ ﻛـﻪ ﻣــﻮرد از آﻧﻬــﺎ5 ﺗﻨﻬــﺎ درV1-V2 ﺑﻠﻨــﺪ در ﻟﻴــﺪﻫﺎيR ﻣــﻮج ﭘـﻨﺞ ﻣـﻮرد از اﻳـﻦ، اﮔﺮ ﻟﻴﺪﻫﺎي ﺧﻠﻔﻲ اﺧﺬ ﻧﻤﻲﺷﺪ.دﻳﺪه ﺷﺪ (Non Q Wave)ﺑﻴﻤﺎران ﺑﺎ ﺗﺸﺨﻴﺺ اﻧﻔﺎرﻛﺘﻮس ﺑﺪون ﻣﻮج .از اﺛﺮات ﻣﻔﻴﺪ ﺗﺮوﻣﺒﻮﻟﻴﺘﻴﻚ ﻣﺤﺮوم ﻣﻲﺷﺪﻧﺪ در ﺣﺎل ﺣﺎﺿﺮ ﻣـﺎ ﺷـﺎﻫﺪ اﻓـﺰاﻳﺶ ﻋـﻮارض داﺧـﻞ (Ejection ﺑﻴﻤﺎرﺳﺘﺎﻧﻲ و ﻛﺎﻫﺶ ﺑﻴـﺸﺘﺮ ﻗـﺪرت ﻋـﻀﻠﻪ ﻗﻠـﺐ و اﻓﺰاﻳﺶ ﻣﺮگ در ﺑﻴﻤﺎران ﺑﺎ اﻧﻔـﺎرﻛﺘﻮسFraction- EF) D ﺧﻠﻔﻲ در ﻣﻘﺎﻳـﺴﻪ ﺑـﺎ دﻳﮕـﺮ اﻧـﻮاع اﻧﻔـﺎرﻛﺘﻮس ﻣـﻲﺑﺎﺷـﻴﻢ ﻛـﻪ ﻣﻲﺗﻮاﻧﺪ ﻧﺎﺷﻲ از ﻛﺎﻫﺶ ﻗﺎﺑﻞ ﺗﻮﺟﻪ در ﺗﺠـﻮﻳﺰ ﺗﺮوﻣﺒﻮﻟﻴﺘﻴـﻚ ﺷﺎﻣﻞ ﺳﻦ ﺑﺎﻻﺗﺮ و وﺟـﻮد ﻋﻮاﻣـﻞ،ﻳﺎ وﺟﻮد ﺧﻄﺮ زﻣﻴﻨﻪاي ﺑﺎﻻ .ﺧﻄﺮ ﻣﺘﻌﺪد ﺑﺎﺷﺪ ﻧﺘﻴﺠﻪ ﮔﻴﺮي Ar ch ive of myocardial infarction in United States (19901993). Observations from the national registry of myocardial infarction. Circulation 1994; 90: 2103-14. 4.Anenymous. The TIMI IIIB investigators. Effects of tissue plasminogen activator and a comparison of early invasive and conservative strategies in unstable angina and non-Q wave myocardial infarction. Results of the TIMI IIIB trial. Thrombolysis in myocardial ischemia. Circulation 1994; 89:1545-56. 5. Guadagnoli E, Hauptman PJ, Ayanian JZ, Pashos CL, McNeil BJ, Cleary PD. Variation in the use of cardiac procedures after myocardial infarction. N Engl J Med 1995; 333:573-8. 6. Agarwal JB, Khaw K, Aurignac F, Locuto A. Importance of posterior chest leads in patients with suspected myocardial infarction, but nondiagnostic, routine 12-lead electrocardiogram. Am J Cardiol 1999; 83(3): 323-6. 7. Wung SF, Drew BJ. New electrocardiographic criteria for posterior wall acute myocardial ischemia validated by a percutaneous transluminal coronary angioplasty model of acute myocardial infarction. 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Electrocardiographic differentiation of the STsegment depression of acute myocardial injury SI دﻛﺘﺮ وﻟﻲ اﻟﻪ ﺧﺪﻳﺮ و ﻫﻤﻜﺎران 26 ﻧﺎﺷﺎﻳﻊAMI در ﻟﻴﺪﻫﺎي ﺧﻠﻔﻲ در ﺑﻴﻤﺎران ﺑﺎSTE ﻧﻤﻲ ﺑﺎﺷﺪ و ﻣﻤﻜﻦ اﺳـﺖ ﻧـﺸﺎﻧﻪ ﭘـﻴﺶ آﮔﻬـﻲ ﺑـﺪ ﺑﻴﻤﺎرﺳـﺘﺎﻧﻲ ﺛﺒـﺖ ﻟﻴـﺪﻫﺎي ﺧﻠﻔـﻲ ﻣﻤﻜـﻦ اﺳـﺖ درAMI در ﺧﻼل.ﺑﺎﺷﺪ در ﻟﻴـﺪﻫﺎي اﺳـﺘﺎﻧﺪاردSTE ﻳﺎﻓﺘﻦ ﮔﺮوﻫﻲ از ﺑﻴﻤـﺎران ﺑـﺪون . ﻛﻤﻚ ﻛﻨﻨﺪه ﺑﺎﺷﺪ،ﻛﻪ از درﻣﺎن ﺗﺮوﻣﺒﻮﻟﻴﺘﻴﻚ ﺳﻮد ﻣﻲﺑﺮﻧﺪ ﺗﺸﻜﺮ و ﻗﺪرداﻧﻲ ﺑﺪﻳﻨﻮﺳﻴﻠﻪ از زﺣﻤﺎت و ﻣﺴﺎﻋﺪت ﻫﻤﻜﺎران ﮔﺮاﻣﻲ در ﺑﺨﺶ ﻣﺮاﻗﺒﺖﻫﺎي وﻳﮋه و اورژاﻧﺲ ﺑﻴﻤﺎرﺳﺘﺎن ﻗﻠـﺐ ﺷـﻬﻴﺪ ﺗـﺸﻜﺮ و،رﺟﺎﻳﻲ ﻛﻪ ﻣﺎ را در اﻧﺠﺎم اﻳﻦ ﻣﻄﺎﻟﻌﻪ ﻳـﺎري ﻧﻤﻮدﻧـﺪ .ﻗﺪرداﻧﻲ ﻣﻲﻧﻤﺎﻳﻴﻢ ﻣﻨﺎﺑﻊ 1. Hennekens CH. Thrombolytic therapy: preand post-GISSI-2, ISIS-3, and GUSTO-1. Clin Cardiol 1994; 17(suppl):115-17. 2. The GUSTO investigators. An international randomized trial comparing four thrombolytic strategies for acute myocardial infarction. N Engl J Med 1993; 329 (10):673-82. 3. Rogers WJ, Bowlby LJ, Chandra MC, French WJ, Gore JM, Lambrew CT, et al. Treatment of 1388 ﭘﺎﻳﻴﺰ،3 ﺷﻤﺎره، ﺳﺎل دوازدﻫﻢ،ﻣﺠﻠﻪ ﻋﻠﻤﻲ ﭘﮋوﻫﺸﻲ داﻧﺸﮕﺎه ﻋﻠﻮم ﭘﺰﺷﻜﻲ اراك www.SID.ir ... در ﻟﻴﺪﻫﺎيST ﺷﻴﻮع و اﻫﻤﻴﺖ ﺑﺎﻟﻴﻨﻲ ﺑﺎﻻ رﻓﺘﻦ ﻗﻄﻌﻪ D infarctions: results in 16185 patients. J Am Coll Cardiol 1995; special issue: 342A. 19. Shah PK, Pichler M, Berman DS, Maddahi J, Peter T, Singh BN, et al. Non-invasive identification of a high risk subset of patients with acute inferior myocardial infarction. Am J Cardiol 1980; 46:915-21. 20. Hlatky MA, Califf RM, Lee KL, Pryor DB, Wagner GS, Rosati RA. Prognostic significance of precordial ST-segment depression during inferior acute myocardial infarction. Am J Cardiol 1985; 55(4): 325-9. 21. Willems JL, Willems RJ, Willems RM, Arnold AER, Van de Werf F, Verstraete M. Significance of initial ST segment elevation and depression for the management of thrombolytic therapy in acute myocardial infarction. Circulation 1990; 82:1147-58. 22. Peterson ED, Hathaway WR, Zabel KM, Pieper KS, Granger CB, Wagner GS, et al. Prognostic significance of precordial STsegment depression during inferior myocardial infarction in the thrombolytic era: results in 16521 patients. J Am Coll Cardiol 1996; 28:305-12. 23. Zalenski RJ, Rydman RJ, Sloan EP, Hahm K, Cook D, Tacker J, et al. Value of posterior and right ventricular leads in comparison to the standard 12-lead electrocardiogram in evaluation of ST-segment elevation in suspected acute myocardial infarction. Am J Cardiol 1997; 79:1579-85. Ar ch ive of due to the left circumflex artery occlusion from that of myocardial ischemia of nonocclusive etiologies. Am J Cardiol 1997; 80:512-3. 13. Perloff JK. The recognition of strictly posterior myocardial infarction by conventional scalar electrocardiography. Circulation 1964; 30:706-18. 14. Shah PK, Pichler M, Berman DS, Madashi J, Peter T, Singh BN, et al. Noninvasive identification of a high risk subset of patients with acute inferior myocardial infarction. Am J Cardiol 1980; 46:915- 21. 15. 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The prognostic importance of anterior STsegment depression in inferior myocardial SI دﻛﺘﺮ وﻟﻲ اﻟﻪ ﺧﺪﻳﺮ و ﻫﻤﻜﺎران 27 1388 ﭘﺎﻳﻴﺰ،3 ﺷﻤﺎره، ﺳﺎل دوازدﻫﻢ،ﻣﺠﻠﻪ ﻋﻠﻤﻲ ﭘﮋوﻫﺸﻲ داﻧﺸﮕﺎه ﻋﻠﻮم ﭘﺰﺷﻜﻲ اراك www.SID.ir Arak Medical University Journal (AMUJ) Autumn 2009; 12(3): 23-28 Original Article Prevalence and clinical value of ST-segment elevation in posterior electrocardiography leads during acute myocardial infarction, Shahid Rajaei hospital, Tehran, 2003 Khadir V¹*, Oraii S² 1-Assistant Professor, Cardiologist, Department of Cardiology, Arak University of Medical Science, Arak, Iran 2- Cardiologist, Interventional Electro physiologist, Day Hospital, Tehran, Iran D Received 26 Apr, 2009 Accepted 2 Sep, 2009 Abstract Ar ch ive of SI Background: Current electrocardiography (ECG) criteria are insensitive for the detection of posterior acute myocardial infarction (AMI) and most of these cases remain undiagnosed. The purpose of this study has been evaluated of prevalence and clinical value of ST-segment in posterior electrocardiography leads during acute myocardial infarction. Materials and Methods: In cross- sectional analytic study, posterior ECG leads (V7, V8 and V9) as well as standard 12 leads in 210 consecutive patients with acute myocardial infarction admitted to CCU wards of Shahid Rijaie hospital. Reinforcing, continuous arrhythmia, hypotension, cardiologic shock, marked heart failure and/or acute pulmonary edema were considered. Related parameters to basic characteristics and next process of patients in two groups with/ without ST- segment elevation in posterior ECG lead were compared. Results: There were 153 patients with ST-segment elevation ≥1 mm in ≥2 contiguous leads. 12.4% patients had STE≥1 mm in ≥2 posterior leads, either as an isolated finding (4.6%) or in association with STE at inferior or lateral sites (7.8%). The standard 12-lead electrocardiogram was normal in two patients and 5 other patients were admitted with the diagnosis of non-Q infarctions. Tall R waves in V1/V2 developed in 5 cases. In-hospital complications were significantly more frequent among patients with STE in posterior leads (47.4% vs. 20.9% respectively, P=0.01). Conclusion: STE in posterior electrocardiography leads is not uncommon during acute myocardial infarction and may portend a worse in-hospital course. Keywords: Electrocardiography, Myocardial infarction, Prognosis *Corresponding author; Email: [email protected] Address: Amir Kabir hospital, Arak, Iran. 28 www.SID.ir