Intracoronary ST-segment shift soon after elective percutaneous coronary intervention accurately predicts
Vruyr Balian1, Michele Galli, Claudio Marcassa
1Cardiologia Interventistica, Azienda Ospedaliera di Busto Arsizio, Varese, Italy. vbalian@aobusto.it
Insights
Intracoronary ST-segment monitoring can quickly identify myocardial damage after percutaneous coronary intervention (PCI), even after successful procedures. This method aids in detecting patients who may need further treatment and extended hospital stays.
Area of Science:
- Cardiology
- Interventional Cardiology
- Biomarker Research
Background:
- Elevated cardiac biomarkers post-percutaneous coronary intervention (PCI) indicate myocardial damage and predict adverse events.
- Assessing periprocedural myocardial damage despite successful PCI is crucial for patient outcomes.
Purpose of the Study:
- To evaluate the efficacy of intracoronary ST-segment recording using a guidewire for rapid identification of myocardial damage post-PCI.
- To determine if intracoronary ST-segment shifts correlate with troponin I levels and predict adverse cardiac events.
Main Methods:
- 108 patients undergoing elective single-vessel PCI had intracoronary ECG recorded via guidewire before and after the procedure.
- Myocardial damage was defined by troponin I increase; intracoronary ST-segment shift > or = 1 mm was considered significant.
- Long-term follow-up data on major coronary events were collected.
Main Results:
- Myocardial damage occurred in 46% of patients, but only 10% had abnormal creatine kinase-MB.
- Intracoronary ST-segment shift after PCI identified 93% of patients with myocardial damage, with 74% sensitivity and 95% specificity.
- ST-segment shift was the sole independent predictor of myocardial damage (OR 54.1, P<0.0001).
Conclusions:
- Intracoronary ST-segment shift effectively identifies myocardial injury post-PCI, even after successful interventions.
- This technique offers a prompt, inexpensive method to detect patients requiring potential adjunctive therapy or longer hospitalization.
Background:
Elevation of cardiac biomarkers after coronary angioplasty (percutaneous coronary intervention [PCI]) reflects periprocedural myocardial damage and is associated with adverse cardiac events. We assessed whether periprocedural myocardial damage that occurs despite successful PCI could be rapidly and easily identified by intracoronary ST-segment recording with the use of a catheter guidewire.
Methods And Results:
In 108 consecutive stable patients undergoing elective single-vessel PCI, we recorded unipolar ECG from the intracoronary guidewire in the distal coronary before PCI and 2 minutes after the last balloon inflation. After PCI, intracoronary ST-segment shift > or = 1 mm from baseline was considered significant. Troponin I levels were measured at baseline and at 8 and 24 hours after intervention, and myocardial damage was defined as troponin I increase above the upper normal value after intervention. All patients had normal cardiac marker values before PCI, and PCI was successful in all (residual stenosis < 20%, Thrombolysis in Myocardial Infarction grade 3 flow). After PCI, long-term follow-up data were collected; myocardial damage was detected in 50 patients (46%), although abnormal creatine kinase-MB values were documented in only 11 (10%). Significant intracoronary ST-segment shift after PCI was present in 40 patients (37%; group A) and absent in the remaining 68 (63%; group B). Procedural myocardial damage was documented in 37 group A patients (93%) and in 13 group B patients (19%; P<0.001); significant ECG changes were found on standard ECG after intervention in only 5 patients (13%) and 1 patient (1%) (P<0.05). Sensitivity of intracoronary ST-segment shift for predicting myocardial damage was 74%, and specificity was 95%, with positive and negative predictive values of 93% and 81%, respectively. On multivariate analysis, intracoronary ST-segment shift was the sole independent predictor of myocardial damage (odds ratio, 54.1; 95% confidence interval, 12.1 to 240; P<0.0001). At a median follow-up of 12+/-5 months, major coronary event-free survival was significantly worse in group A patients (log-rank test chi2=4.0; P<0.05).
Conclusions:
After successful single-vessel PCI, intracoronary ST-segment shift allows the prompt and inexpensive identification of patients developing myocardial injury, who may require adjunctive therapy and longer in-hospital stay.
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