Determinants of prognostically relevant intracoronary electrocardiogram ST-segment shift during coronary balloon occlusion

de Marchi, Stefano Fausto; Streuli, Sabina; Haefeli, Pascal; Gloekler, Steffen; Traupe, Tobias; Warncke, Cornelius; Rimoldi, Stefano F; Stortecky, Stefan; Steck, Hélène; Seiler, Christian (2012). Determinants of prognostically relevant intracoronary electrocardiogram ST-segment shift during coronary balloon occlusion. American journal of cardiology, 110(9), pp. 1234-1239. New York, N.Y.: Elsevier 10.1016/j.amjcard.2012.06.023

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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.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Cardiovascular Disorders (DHGE) > Clinic of Cardiology

UniBE Contributor:

de Marchi, Stefano; Traupe, Tobias; Rimoldi, Stefano; Stortecky, Stefan and Seiler, Christian

Subjects:

600 Technology > 610 Medicine & health

ISSN:

0002-9149

Publisher:

Elsevier

Language:

English

Submitter:

Factscience Import

Date Deposited:

04 Oct 2013 14:37

Last Modified:

09 Jul 2014 11:23

Publisher DOI:

10.1016/j.amjcard.2012.06.023

PubMed ID:

22835408

Web of Science ID:

000311003400005

URI:

https://boris.unibe.ch/id/eprint/14984 (FactScience: 222133)

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