Stability of multilead ST-segment "fingerprints" over time after percutaneous transluminal coronary angioplasty and its usefulness in detecting reocclusion.

Multilead ST-segment recordings taken during percutaneous transluminal coronary angioplasty (PTCA) could function as an individualized noninvasive template or "fingerprint," useful in evaluating transient ischemic episodes after leaving the catheterization laboratory. To evaluate the reproducibility of such ST-segment patterns over time, these changes were analyzed in patients grouped according to the time between occlusion and reocclusion. For the patients in group 1, the study required comparing their "fingerprints" in repeat balloon inflation during PTCA (reocclusion in less than 1 hour), for those in group 2, comparing ST "fingerprints" during PTCA with ST changes during spontaneous early myocardial infarction (reocclusion in 24 hours) and in group 3, comparing ST "fingerprints" with ST changes during repeat PTCA for restenosis greater than 1 month after the initial PTCA. The ST "fingerprints" among the 20 patients in group 1 were identical in 14 cases (70%) and clearly related in another 4 (20%). Of the 23 patients in group 2, 12 (52%) had the same and 8 (35%) had related patterns. Of 19 patients in group 3, 8 (42% had the same pattern and 8 (42%) had related patterns. Thus, ST fingerprints were the same or clearly related with reocclusion in the same patient from less than 1 hour to greater than 1 month after initial occlusion in 87% of patients overall, in 90% in less than 1 hour, in 87% in less than 24 hours and in 84% greater than 1 month later. Multilead pattern ST-segment "fingerprints" may serve as a noninvasive marker for detecting site-specific reocclusion.

Quantitative ST-segment recovery following angiographically successful angioplasty: a useful warning of early complications.

The angiographic/anatomic appearance of the TCA site and transstenotic gradient trending are two available intraprocedural variables that help to identify patients at high risk for early complications after successful angioplasty. We have reported on an additional variable, the rate of ST recovery following the final balloon deflation as a physiologic marker to identify patients at risk for early complications. Slow ST recovery was present in 52% of patients with early complications of myocardial infarction, urgent or emergent coronary bypass surgery, and/or death, whereas normal ST recovery was seen in 97% of patients with uncomplicated courses. ST trending is a non-invasive modality that is available in all patients undergoing TCA and should be a useful adjunct in identifying patients at high and low risk for early major complications following angiographically successful angioplasty. A prospective study of ST recovery during TCA deserves consideration.