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

Am J Cardiol. 2012 Nov 1;110(9):1234-9. doi: 10.1016/j.amjcard.2012.06.023. Epub 2012 Jul 25.


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.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Angioplasty, Balloon, Coronary / methods
  • Angioplasty, Balloon, Coronary / mortality
  • Balloon Occlusion / methods*
  • Balloon Occlusion / mortality
  • Cohort Studies
  • Coronary Disease / diagnosis*
  • Coronary Disease / mortality
  • Coronary Disease / therapy
  • Coronary Occlusion / mortality
  • Coronary Occlusion / physiopathology*
  • Electrocardiography / methods*
  • Female
  • Humans
  • Male
  • Middle Aged
  • Multivariate Analysis
  • Predictive Value of Tests
  • Prognosis
  • Regression Analysis
  • Risk Assessment
  • Sensitivity and Specificity
  • Survival Analysis
  • Time Factors