title: Determinants of prognostically relevant intracoronary electrocardiogram ST-segment shift during coronary balloon occlusion.
abstract: The prognostic relevance of quantitative an intracoronary occlusive electrocardiographic (ECG) ST-segment shift and its determinants have not been investigated in humans. In 765 patients with chronic stable coronary artery disease, the following simultaneous quantitative measurements were obtained during a 1-minute coronary balloon occlusion: intracoronary ECG ST-segment shift (recorded by angioplasty guidewire), mean aortic pressure, mean distal coronary pressure, and mean central venous pressure (CVP). Collateral flow index (CFI) was calculated as follows: (mean distal coronary pressure minus CVP)/(mean aortic pressure minus CVP). During an average follow-up duration of 50 ± 34 months, the cumulative mortality rate from all causes was significantly lower in the group with an ST-segment shift <0.1 mV (n = 89) than in the group with an ST-segment shift ≥0.1 mV (n = 676, p = 0.0211). Factors independently related to intracoronary occlusive ECG ST-segment shift <0.1 mV (r(2) = 0.189, p <0.0001) were high CFI (p <0.0001), intracoronary occlusive RR interval (p = 0.0467), right coronary artery as the ischemic region (p <0.0001), and absence of arterial hypertension (p = 0.0132). "High" CFI according to receiver operating characteristics analysis was ≥0.217 (area under receiver operating characteristics curve 0.647, p <0.0001). In conclusion, absence of ECG ST-segment shift during brief coronary occlusion in patients with chronic coronary artery disease conveys a decreased mortality and is directly influenced by a well-developed collateral supply to the right versus left coronary ischemic region and by the absence of systemic hypertension in a patient's history.
authors: Department of Cardiology, University Hospital, Bern, Switzerland.
authors: Stefano Fausto
authors: SF
authors: de Marchi
authors: Sabina
authors: S
authors: Streuli
authors: Pascal
authors: P
authors: Haefeli
authors: Steffen
authors: S
authors: Gloekler
authors: Tobias
authors: T
authors: Traupe
authors: Cornelius
authors: C
authors: Warncke
authors: Stefano F
authors: SF
authors: Rimoldi
authors: Stefan
authors: S
authors: Stortecky
authors: Hélène
authors: H
authors: Steck
authors: Christian
authors: C
authors: Seiler
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000379:methods / Q000401:mortality; D021721:Balloon Occlusion / Q000379:methods* / Q000401:mortality; D015331:Cohort Studies; D003327:Coronary Disease / Q000175:diagnosis* / Q000401:mortality / Q000628:therapy; D054059:Coronary Occlusion / Q000401:mortality / Q000503:physiopathology*; D004562:Electrocardiography / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011237:Predictive Value of Tests; D011379:Prognosis; D012044:Regression Analysis; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D016019:Survival Analysis; D013997:Time Factors