title: Intracoronary electrocardiogram ST-segment elevation in patients with non-ST-segment elevation myocardial infarction and its association with culprit lesion location and myocardial injury.
abstract: OBJECTIVE
  An intracoronary electrocardiogram (IC-ECG) is a sensitive method to detect local myocardial ischaemia. We investigated the prevalence of IC-ECG ST-segment elevation (STE) with respect to culprit lesion location in patients with non-ST-segment elevation myocardial infarction (NSTEMI) and its relationship with elevated levels of cardiac biomarkers.
  
  
  RESULTS
  We examined 87 NSTEMI patients who underwent IC-ECG recording by locating the insulated polymer-coated guidewire distal to the culprit lesion before percutaneous coronary intervention (PCI). Cardiac biomarkers were serially examined. IC-ECG STE was observed in 24 patients (27.6%) before PCI, and was significantly more frequent in patients with LCx culprit lesions (LAD vs. LCx vs. RCA, 12.1% vs. 53.3% vs. 16.7%; p<0.001). Peak cardiac troponin I (cTnI) values were associated with IC-ECG STE, ejection fraction (EF), cTnI values on admission, and type B2/C lesions. In multivariate analysis, IC-ECG STE (odds ratio [OR], 5.04; 95% confidence intervals [CI]: 1.51-16.85; p=0.009), and EF (OR, 0.95; 95% CI: 0.90-1.00; p=0.043) were predictors of greater peak cTnI values.
  
  
  CONCLUSIONS
  IC-ECG STE was not uncommon in NSTEMI patients, particularly those with LCx culprit lesions. IC-ECG monitoring before PCI may help identify NSTEMI patients with high risk of greater myocardial injury.
authors.affiliation: Department of Cardiology, Tsuchiura Kyodo General Hospital, Tsuchiura, Japan.
authors.forename: Keiichi
authors.initials: K
authors.lastname: Hishikari
authors.forename: Taishi
authors.initials: T
authors.lastname: Yonetsu
authors.forename: Tetsumin
authors.initials: T
authors.lastname: Lee
authors.forename: Kenji
authors.initials: K
authors.lastname: Koura
authors.forename: Tadashi
authors.initials: T
authors.lastname: Murai
authors.forename: Toshiyuki
authors.initials: T
authors.lastname: Iwai
authors.forename: Takamitsu
authors.initials: T
authors.lastname: Takagi
authors.forename: Mitsuaki
authors.initials: M
authors.lastname: Isobe
authors.forename: Yoshito
authors.initials: Y
authors.lastname: Iesaka
authors.forename: Tsunekazu
authors.initials: T
authors.lastname: Kakuta
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D056988:Anterior Wall Myocardial Infarction; D016022:Case-Control Studies; D015331:Cohort Studies; D004562:Electrocardiography / Q000379:methods*; D022062:Electrophysiologic Techniques, Cardiac / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000097:blood / Q000175:diagnosis* / Q000628:therapy; D062645:Percutaneous Coronary Intervention / Q000379:methods; D011446:Prospective Studies; D019210:Troponin I / Q000097:blood
chemical_list: D019210:Troponin I