Intracoronary Electrocardiogram Recording With a Bare-Wire System

Abstract

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.

Prediction of troponin elevation by means of intracoronary electrocardiogram during percutaneous coronary intervention of coronary bifurcation lesions (from COronary SIde Branch Residual IschemiA and COllateralization Assessment Study; COSIBRIA & Co Study

“…The present method is more comprehensive, however, as it provides a base for demonstrating the exact zone location source of possible troponin rise after intervention. In the subgroup of our patients with undetectable baseline troponin values, as in the cited studies, we demonstrated higher sensitivity and better negative predictive value (100%) in comparison with previous studies, with a slightly lower specificity (91% in our study vs. 95% in the Balian et al [8] study and 92% in the study by Uetani et al [10]). Since a different distribution of icECG shifts exists in the MB, this may explain the different sensitivity and specificity detected in previous studies.…”

“…Despite the lower risk patient cohort, the frequency of postprocedural enzyme increase was almost identical to our patient population, although no data were provided about sensitivity and specificity of method regarding > 5 × N troponin I increase. In 339 patients with non-bifurcation PCI of non-complex lesions probed with icECG, Uetani et al [10] demonstrated sensitivity of 55%, specificity of 92%, PPV of 69% and NVP of 87% (the absolute number of patients with increase in troponin and relative icECG changes was not provided). Neither of those studies used a reference point, nor was the wire positioning before and after intervention described.…”

“…Hence, setting a different threshold for ST segment shift can subsequently improve the sensitivity of the method. Our definition was based on previous studies with icECG recordings and our own patient studies for examination of predictors of periprocedural necrosis [6][7][8][9][10][11][12]. Moreover, some of our patients may not have had a sufficiently long bout of ischaemia to cause myonecrosis.…”

“…The unipolar intracoronary electrocardiogram (icECG) recording from angioplasty guidewire represents local epicardial ECG and has been shown to be more sensitive and more reliable in detecting regional myocardial ischaemia during balloon inflation than standard ECG [6][7][8][9][10]. The icECG detects earlier ischaemia and the changes are more prominent than surface ECG.…”

“…Moreover, the post-procedural myocardial injury after uncomplicated PCI is not uncommon [2-4] with a frequency of 5% to 30%. Although this is thought to have no clinical significance, clinical trials demonstrated an increased risk of adverse cardiac events in patients with periprocedural myonecrosis [5].The unipolar intracoronary electrocardiogram (icECG) recording from angioplasty guidewire represents local epicardial ECG and has been shown to be more sensitive and more reliable in detecting regional myocardial ischaemia during balloon inflation than standard ECG [6][7][8][9][10]. The icECG detects earlier ischaemia and the changes are more prominent than surface ECG.…”