ST and ventricular gradient dynamics during percutaneous transluminal coronary angioplasty

Diagnosis/triage in the hyperacute phase of the acute coronary syndrome (ACS) is mainly based on the ECG. There are serious limitations in the interpretation of the ST segment in the ECG in the setting of ACS, so there is need for the investigation of alternative or additional ECG features. Therefore we studied the potential role of the Ventricular Gradient (VG) in acute ischemia. We computed, in ECGs of 84 patients (pts) recorded during elective PTCA, the maximal values of VG and ST, and the changes with respect to baseline, ΔST and ΔVG. In most pts, ΔST and ΔVG assumed the same direction and changed proportional in magnitude;55% of the pts responded to balloon inflations with ST elevation (STE) ECGs, 45% with non-STE (NSTE) ECGs. In a subset of 31pts with sestamibi area-at-risk (AAR) assessment, ROC analysis showed comparable performance of the maximal ST, ΔST, VG and ΔVG values to discriminate small and large AARs (areas under the curve >;0.80, P<;0.01). In conclusion, our study shows that: 1) the VG has, in addition to ST, a potential role in detecting ischemia and in relating this to the area at risk, and 2) the STE/NSTE classification of ischemic ECGs is not very meaningful to discriminate between complete and partial occlusions.