Intracoronary electrocardiogram recording with a bare-wire system: perioperative ST-segment elevation in the intracoronary electrocardiogram is associated with myocardial injury after elective coronary stent implantation.
OBJECTIVE
With an intracoronary electrocardiogram (IcECG) recording with insulated polymer-coated guidewire without balloon catheter, we sought to examine the association between ST-segment elevation in the IcECG after elective stenting and myocardial injury.


BACKGROUND
An IcECG is a sensitive method to detect local myocardial ischemia. Occasionally, persistent ST-segment elevation in the IcECG was recorded after successful coronary intervention. Conventionally IcECG was recorded with a guidewire and over-the-wire system.


METHODS
Patients who underwent elective stenting were enrolled (n = 339). The IcECG both at baseline and after procedure were obtained with a guidewire with an insulating coated shaft suitable for IcECG recording. The presence of chest pain after percutaneous coronary intervention was recorded. Cardiac biomarkers were examined 18 h after the procedure.


RESULTS
The ST-segment elevation in the IcECG after procedure was recorded in 65 patients, and no change was recorded in 274 patients. Troponin-T, creatine phosphokinase, and creatine kinase MB isoform after the procedure were significantly higher in patients with post-procedural ST-segment elevation in the IcECG than patients without ST-segment elevation. Multivariate analysis demonstrated that ST-segment elevation in the IcECG is an independent predictor of post-procedural myocardial injury. The incidence of ST-segment elevation in the IcECG was significantly higher in patients with post-procedural chest pain than patients without chest pain (p < 0.001).


CONCLUSIONS
We demonstrated a facile method to record IcECG with a guidewire with a polymer-coated shaft. The IcECG is a useful method for predicting post-procedural myocardial injuries.
Uetani
Tadayuki
T
Department of Cardiology, Chubu Rosai Hospital, Nagoya, Japan. uetani@med.nagoya-u.ac.jp
Amano
Tetsuya
T
Kumagai
Soichiro
S
Ando
Hirohiko
H
Yokoi
Kiminobu
K
Yoshida
Tomohiro
T
Kato
Bunichi
B
Kato
Masataka
M
Marui
Nobuyuki
N
Nanki
Michio
M
Matsubara
Tatsuaki
T
Ishii
Hideki
H
Izawa
Hideo
H
Murohara
Toyoaki
T
D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects*; D015415:Biomarkers; D002637:Chest Pain; D017023:Coronary Angiography; D003331:Coronary Vessels / Q000293:injuries*; D017558:Elective Surgical Procedures / Q000009:adverse effects*; D004562:Electrocardiography; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000175:diagnosis / Q000628:therapy*; D009206:Myocardium; D019990:Perioperative Care; D015607:Stents / Q000009:adverse effects*; D013997:Time Factors; D014336:Troponin
D015415:Biomarkers; D014336:Troponin