Search

Background Postinterventional ischemic myocardial dysfunction and its sequelae are still not well understood. Methods and Results To gain further insight into the immediate physiologic consequences of coronary interventions and to better understand the nature of changes that result from such interventions, we analyzed 96 electromechanical maps from 48 patients before and after successful, uncomplicated percutaneous coronary interventions (PCI). A NOGA system was used to construct the map of the endocardial surface. Reproducibility was confirmed by constructing 10 additional maps in 5 patients who did not undergo an intervening procedure. Discordant areas were defined as those with preserved unipolar voltage (≥7.5 mV) and diminished linear local shortening (≤12.5%). On the basis of comparison of the variations in the discordance values (%) in the reproducibility group, patients were considered improved (lower values), worsened (higher values), or unchanged. In the reproducibility group, the mean variation in discordance was 2.18% ± 1.26%, whereas in the PCI group, it was 21.97% ± 18.47%. In the PCI group (rotational atherectomy subgroup [n = 10] and stent subgroup [n = 38]), left ventricular discordance values improved in 19 patients (39.6%), worsened in 24 (50%), and remained the same in 5 (10.4%). Of all variables analyzed, only abciximab was significantly associated with postintervention improvement in discordance ( P =.02; odds ratio 0.165, 95% CI 0.03-0.88), regardless of the type of intervention performed ( P =.61), whereas heparin alone was associated with more discordance after intervention (odds ratio 6.07, 95% CI 1.14-32.40). Conclusions We assessed the effect of percutaneous revascularization on myocardium by use of electromechanical data. For the first time, changes in linear local shortening in areas of preserved unipolar voltage were quantified, and worsening after successful Thrombolysis In Myocardial Infarction grade III coronary interventions was registered. The only variable associated with improvement on electromechanical data after interventions was the use of abciximab. This raises the question of the possible potential of this new diagnostic tool in assessing and quantifying postinterventional microvasculature pathological changes. (Am Heart J 2002;144:693-701.)

The ability to estimate the rate of a new target vessel revascularization (TVR) after bare metal coronary stenting is an important issue, as the systematic use of drug-eluting stents is still limited by its high costs.We sought to create a predictive score for the possibility of a new TVR after bare metal stenting.Clinical and angiographic characteristics of a prospective cohort of 848 patients were included in a dedicated database. Independent predictors of 1-year TVR were identified by multivariate analysis, and the score points were assigned according to the relative risk ratio of 1-year TVR.The 1-year TVR rate in the 848 patients was 7.4%. By multivariate analysis, reference diameter, lesion length and diabetes mellitus were retained in the final model (Hosmer-Lemeshow goodness-of-fit test = 2.339; p = 0.969). The increase of 1-year TVR rates was almost linear, with each score level (0 = 1.4%, 1 = 4.5%, 2 = 7.1%, 3 = 10.4% and 4 of 5 = 15.7%; r = 0.90; p0.001), and the p of the Chi-square test for trend was0.0001.This score can stratify patients with very low and high TVR rates and can be used as a simple clinical tool for the prediction of a new revascularization procedure in daily practice.