非ST段抬高型心肌梗死患者缺血性J波与罪犯血管的关系OA

Objective To investigate the characteristics of ischemic J wave and its relationship with culprit vessel localization in patients with non-ST-segment elevation myocardial infarction(NSTEMI)complicated by acute complete occlusion of a single culprit vessel.Methods A total of 150 NSTEMI patients who had undergone emergency percutaneous coronary intervention(PCI)were retrospectively enrolled.All patients were confirmed by coronary angiography to have acute complete occlusion of a single culprit vessel and underwent resting 18-lead electrocardiogram examination before the procedure.According to the type of culprit vessel,patients were divided into left anterior descending artery(LAD)group,left circumflex artery(LCX)group,and right coronary artery(RCA)group,with 50 cases in each group.The incidence and lead distribution characteristics of ischemic J wave were compared among the three groups.Differences in peak cardiac troponin T(cTnT)level,left ventricular ejection fraction(LVEF),ST-T improvement after PCI,and short-term outcomes during hospitalization were also analyzed between patients with positive and negative ischemic J wave.Results Among the 150 NSTEMI patients,the positive rate of ischemic J wave was 35.33％(53/150),with the highest rate in the LCX group[50.00％(25/50)],followed by the RCA group[34.00％(17/50)],and the lowest in the LAD group[22.00％(11/50)];the difference among the three groups was statistically significant(x2=8.636,P=0.013).The lead distribution of ischemic J wave showed good consistency with the perfusion territory of the culprit vessel:LAD-related occlusion was mainly observed in anterior leads,LCX-related occlusion mainly in lateral leads,and RCA-related occlusion mainly in inferior leads.Compared with ischemic J-wave-negative patients,patients with positive ischemic J wave had higher peak cTnT levels(P=0.002),but there were no statistically significant differences in LVEF,proportion of patients with ST-T improvement after PCI,or short-term clinical outcomes during hospitalization between the two groups(all P＞0.05).Conclusion In NSTEMI patients with acute complete occlusion of a single culprit vessel,ischemic J wave is not uncommon,with the highest incidence observed in LCX-related occlusion.This wave highly coincides with the culprit vessel's perfusion territory,suggesting that it may reflect local repolarization abnormalities.For NSTEMI patients with suspected LCX lesions or atypical ST-segment elevation,attention to J-wave elevation may assist in identifying acute complete occlusion.