Abstract 17396: Post-PCI ST-Segment Elevation of Intracoronary Electrocardiogram is Associated With Worse Outcome in Non-ST segment Elevation Myocardial Infarction
Background: Risk assessment impacts decision making regarding therapeutic strategy and patient management as well as the prognosis prediction in patients with non-ST segment elevation myocardial infarction (NSTEMI). Previous studies have reported the intracoronary electrocardiogram (IC-ECG) is more sensitive in detection of myocardial damage than surface ECG and provides the information of the severity of myocardial necrosis. We investigated the relationship between IC-ECG ST-segment elevation (STE) recorded before and after percutaneous coronary intervention (PCI) and adverse cardiac events in patients with NSTEMI.
Methods and Results: We examined 111 NSTEMI patients who underwent PCI with IC-ECG recording. IC-ECG STE was defined as > 0.2mV STE in the territory at the risk by locating the guide-wire distal to the culprit lesion. Cardiac biomarkers were serially measured. After PCI, both in-hospital and long-term follow-up data were collected. Lesion locations were 39 in LAD, 39 in LCx, and 33 in RCA. IC-ECG STE was observed in 37 patients (33.3%) immediately before PCI, and in 36 patients (32.4%) at the end of the PCI procedure. Peak cardiac biomarkers were significantly more elevated in patients with IC-ECG STE before PCI than those without (CK-MB 91IU/L (44-266) vs. 36IU/L (19-61); p=0.008, cTnI 32.5ng/mL (18.2-107.8) vs. 9.1ng/mL (2.1-23.5); p=0.007), and also in patients with IC-ECG STE after PCI than those without (CK-MB 104IU/L (52-239) vs. 36IU/L (19-59); p<0.001, cTnI 31.9ng/mL (18.0-104.5) vs. 8.2ng/mL (1.8-21.4); p<0.001). At the median follow-up of 22 months (16-27 months), adverse cardiac event-free survival rate was significantly worse in patients with IC-ECG STE after PCI than those without (long-rank testχ2=13.4; p<0.001). Cox proportional hazards analysis showed IC-ECG STE after PCI (hazard ratio, 2.28; 95% confidence interval, 1.17 to 4.43; p=0.016) and ejection fraction at admission (hazard ratio, 0.95; 95% confidence interval, 0.93 to 0.97; p<0.001) were independent predictors of long term adverse cardiac events.
Conclusions: The present results suggest post-procedural STE in IC-ECG may help identify high risk patients with greater myocardial injury and adverse cardiac events in patients with NSTEMI .
- © 2013 by American Heart Association, Inc.