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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

Tadayuki Uetani, MD, PhD^_*,_*, Tetsuya Amano, MD, PhD^_*, Soichiro Kumagai, MD^_*, Hirohiko Ando, MD^_*, Kiminobu Yokoi, MD^_*, Tomohiro Yoshida, MD^_*, Bunichi Kato, MD, PhD^_*, Masataka Kato, MD^_*, Nobuyuki Marui, MD, PhD^_*, Michio Nanki, MD, PhD^_*, Tatsuaki Matsubara, MD, PhD, Hideki Ishii, MD, PhD, Hideo Izawa, MD, PhD, Toyoaki Murohara, MD, PhD

^_* Department of Cardiology, Chubu Rosai Hospital, Nagoya, Japan
Department of Internal Medicine, Aichi-Gakuin School of Dentistry, Nagoya, Japan
Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan

^_* Reprint requests and correspondence: Dr. Tadayuki Uetani, Department of Cardiology, Chubu Rosai Hospital, 1-10-6, Komei, Minato-ku, Nagoya, Japan (Email: uetani{at}med.nagoya-u.ac.jp).

Objectives: 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.

Key Words: coronary intervention • intracoronary electrocardiogram • myocardial injury

Abbreviations and Acronyms   CK-MB = creatine kinase-MB   IcECG = intracoronary electrocardiogram   PCI = percutaneous coronary intervention   TIMI = Thrombolysis In Myocardial Infarction   TnT = troponin-T