摘要目的：通过研究缺血性心脏病、不稳定型心绞痛患者心电图及超声心动图的异常改变，对比冠状动脉造影结果，旨在对冠状动脉三支病变再认识。方法选取缺血性心脏病、不稳定型心绞痛行冠状动脉造影患者2654例，将冠状动脉造影所获得的结果与心电图、超声心动图表现进行统计分析。结果（1）心电图、超声心动图的异常改变对冠状动脉三支病变有一定的预测价值，差异均有统计学意义（χ2＝9．02、14．36，均 P ＜0．01）。心电图对冠状动脉三支病变的敏感性为71．46％，特异性为27．47％，假阳性率为62．26％，假阴性率为28．50％；超声心动图对冠状动脉三支病变的敏感性为61．27％，特异性为27．08％，假阳性率为72．91％，假阴性率为38．72％。（2）冠状动脉三支病变患者心绞痛发作时，心电图检查改变多出现在8个以上导联，心电图胸前导联终末正向 T 波发生率均高于90％，Ⅲ导联心电图 fQRS 波群或低电压改变，约占心绞痛发作时心电图的82．61％，AVR 导联 ST 段抬高约占发作心电图的56．52％。结论心电图及超声心动图的异常改变在一定程度上能预测冠状动脉三支病变；冠状动脉三支病变患者心绞痛急性发作期心电图有特征性波形改变。

abstractsObjective To further recognize the coronary artery three vessel disease by studying the abnormal change of the electrocardiogram(ECG)and echocardiography of ischemic heart disease patients and unstable angina pectoris patients,and to analyze the results of coronary angiography.Methods Coronary arteriography for 2 654 patients diagnosed as ischemic heart disease,unstable angina pectoris,were conducted and the result of coronary arteriography were compared with the ECG and echocardiography.Results There were certain statistically significant correlation among the ECG,echocardiography abnormal change and three vessel coronary artery disease(ECG:χ2 =9.02,P <0.01;echocardiography:χ2 =14.36,P <0.01).The sensitivity,specificity,false positive rate,and false negative rate of ECG were 71.46%,27.47%,62.26% and 28.50% respectively.The sensitivity,specificity,false positive rate, and false negative rate of echocardiography were 61.27%,27.08%,72.91% and 38.72% respectively.ECG′s change of patients appear in 8 or more leads when angina pectoris attacks exist,the incidence of chest lead terminal positive T wave were higher than 90.00%.Ⅲ lead fQRS wave group or low voltage changeed and AVR lead ST seg-ment elevation were accounting for 82.61% and 56.52% respectively.Conclusion There are certain correlation and predictive value among the ECG,echocardiography and three vessel coronary artery disease.There are characteristic waveform change of ECG when angina pectoris attacks exist.