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The aim of the study is to explore the differences in the rate of procedural ischemia after bifurcation lesion PCI detected with intracoronary electrocardiography (icECG) and its consequent adverse events.
After placement of intracoronary guidewires in the main branch (MB) and side branch (SB) the uninsulated proximal wire ends were connected to unipolar V leads. Intracoronary unipolar ECGs were recorded before, during and after stent placement and at the end of the procedure. We recorded icECG signal from SB after stent placement in MB. Finally, the coronary wire was placed in every distal vessel with reference caliber >1.0mm, as well as in MB just below the stent, “mapping” zones for ischemia presence and distribution. Changes in ST-segment, QRS complex, R/S amplitude, during and at the end of PCI were analyzed. Provisional T-stenting was the default strategy.
The patient population consists of 232 patients with stable/unstable angina: 67% males, mean age 65±9, diabetics 37%, 34% had previous MI, 47% previous PCI and 60% multivessel disease. Main vessel treated - LAD (74%). The true bifurcation lesions (Medina xx1) were 56.7%. SB icECG elevation after stenting the main branch was found in 68,6% of patients. After stenting MB, SB diameter stenosis >75% was found in 48,3% (51,6 had STE and 49,4 % did not have STE). On multivariate analysis independent predictor for mortality were parameter of i.c. ECG: residual icECG ST elevation in the side branch after stent placement in MB (p=.005), the difference in QRS complex width (pre-post PCI) in SB region, the R/S amplitude ratio of SB QRS complex.
The acute ischemia detected by distribution of icECG changes in SB is predictive for mortality.
IMAGING: FFR and Physiologic Lesion Assessment