Prognozowanie wzrostu stężenia troponiny na podstawie elektrokardiogramu wewnątrzwieńcowego wykonanego w trakcie przezskórnej interwencji wieńcowej w obrębie rozwidlenia tętnic wieńcowych (dane z badania COronary SIde Branch Residual IschemiA and COllater

Dobrin Vassilev, Liubomir Dosev, Gianluca Rigatelli, Kiril Karamfiloff, Hristo Popov, Lachezar Nikolov, Kristian Ivanov, Plamena Entcheva-Dimitrov, Slawomir Golebiewski, Robert J. Gil, Ghassan S. Kassab, Jacek Bil
2016 Kardiologia polska  
A b s t r a c t Background: The influence of periprocedural ischaemia on coronary artery bifurcation stenting (percutaneous coronary intervention [PCI]) remains uncertain. Aim: To determine the differences in rates of end procedural ischaemia after bifurcation lesion PCI detected with intracoronary electrocardiography (icECG). Methods: Unipolar icECGs were recorded before, during, and after stent placement and at the end of procedure in side branch (SB) and main branch (MB). Coronary wire was
more » ... Coronary wire was placed in all distal vessels with diameter > 1.5 mm to "map" the distal zones of ischaemia. The patient population consisted of patients with stable/unstable angina with troponin I evaluated before and after PCI. Results: We studied 147 patients (68% males) with mean age of 64 ± 9 years. One hundred and forty-two patients had icECG recordings at the end of PCI from all locations of the treated region; 36% of patients had MB ST segment elevation (STE) and 31% had icECG STE in the SB region (p = 0.378). The icECG had sensitivity of 82% and specificity of 81% to detect troponin I elevation, with positive predictive value of 81% and negative predictive value of 83%. The independent predictors of troponin increase (> 5 × N) were: sex (for female gender, OR = 0.130, CI 0.017-0.995, p = 0.049), previous myocardial infarction (OR = 33.23, CI 2.802-394.1, p = 0.005), and icECG STE in MB or SB or occlusion of secondary SB (OR = 7.877, CI 2.474-25.07, p < 0.001) and for any troponin elevation were double product -SBPxHR (OR = 0.999, CI 0.999-1.00, p = 0.022) and icECG STE in MB or SB or occlusion of secondary SB (OR = 9.762, CI 3.273-29.12, p < 0.001). Conclusions: Intracoronary electrocardiography is a highly sensitive and specific method for determination of ischaemic regions and prediction of elevated troponin I. Kardiol Pol 2016; 74, 9: 943-953 www.kardiologiapolska.pl Dobrin Vassilev et al.
doi:10.5603/kp.a2016.0057 pmid:27112944 fatcat:fi624gqs4zcprid2sijxmnaknu