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ST ‐segment elevation on intracoronary electrocardiogram after percutaneous coronary intervention is associated with worse outcome in patients with non‐ ST ‐segment elevation myocardial infarction
Author(s) -
Hishikari Keiichi,
Kakuta Tsunekazu,
Lee Tetsumin,
Murai Tadashi,
Yonetsu Taishi,
Isobe Mitsuaki
Publication year - 2016
Publication title -
catheterization and cardiovascular interventions
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.988
H-Index - 116
eISSN - 1522-726X
pISSN - 1522-1946
DOI - 10.1002/ccd.26072
Subject(s) - medicine , cardiology , percutaneous coronary intervention , myocardial infarction , conventional pci , st segment , hazard ratio , electrocardiography , culprit , st elevation , confidence interval
Objectives We sought to examine whether intracoronary electrocardiogram (IC‐ECG) assessment in patients with non‐ST‐segment elevation myocardial infarction (NSTEMI) can predict cardiac outcomes. Background There has been no data correlating myocardial damage and cardiac events with an IC‐ECG ST‐segment change after percutaneous coronary intervention (PCI) in NSTEMI patients. Methods We examined 111 NSTEMI patients undergoing PCI with an IC‐ECG recording. IC‐ECG ST‐segment elevation (STE) was defined as >0.1 mV in the risk area, located by placing the guidewire distal to the culprit lesion. Clinical characteristics and in‐hospital and long‐term follow‐up adverse cardiac event rates were compared between IC‐ECG STE and non‐IC‐ECG STE groups at the completion of PCI. Results IC‐ECG STE was observed in 36 patients (32.4%) immediately after PCI. Peak cardiac biomarkers were significantly elevated in patients with IC‐ECG STE versus those without (cardiac troponin I 31.9 ng/mL (18.0–104.5) vs. 8.2 ng/mL (1.8‐21.4); P < 0.001). At a median follow‐up of 35 months, the cardiac event free rate was significantly worse in patients with IC‐ECG STE than in those without (long‐rank test χ 2 = 10.9; P = 0.001). Cox proportional hazards analysis showed IC‐ECG STE (hazard ratio, 2.54; 95% confidence interval [CI], 1.38–4.70; P = 0.003) was an independent predictors of cardiac events. Conclusions The present study suggests that presence of IC‐ECG STE might help identify high‐risk NSTEMI patients with greater myocardial injury leading to adverse cardiac events. © 2015 Wiley Periodicals, Inc.