Intracoronary ECG has a good ability to predict functionally significant stenosis at the SB after MV stenting during bifurcation PCI. This method provides a novel strategy to assess the significance of an SB lesion without the need of a pressure wire.

A b s t r a c t Background:The influence of periprocedural ischaemia on coronary artery bifurcation stenting (percutaneous coronary intervention [PCI]) remains uncertain. Aim:To determine the differences in rates of end procedural ischaemia after bifurcation lesion PCI detected with intracoronary electrocardiography (icECG).Methods: Unipolar icECGs were recorded before, during, and after stent placement and at the end of procedure in side branch (SB) and main branch (MB). Coronary wire was placed in all distal vessels with diameter > 1.5 mm to "map" the distal zones of ischaemia. The patient population consisted of patients with stable/unstable angina with troponin I evaluated before and after PCI. Results:We studied 147 patients (68% males) with mean age of 64 ± 9 years. One hundred and forty-two patients had icECG recordings at the end of PCI from all locations of the treated region; 36% of patients had MB ST segment elevation (STE) and 31% had icECG STE in the SB region (p = 0.378). The icECG had sensitivity of 82% and specificity of 81% to detect troponin I elevation, with positive predictive value of 81% and negative predictive value of 83%. The independent predictors of troponin increase (> 5 × N) were: sex (for female gender, OR = 0.130, CI 0.017-0.995, p = 0.049), previous myocardial infarction (OR = 33.23, CI 2.802-394.1, p = 0.005), and icECG STE in MB or SB or occlusion of secondary SB (OR = 7.877, CI 2.474-25.07, p < 0.001) and for any troponin elevation were double product -SBPxHR (OR = 0.999, CI 0.999-1.00, p = 0.022) and icECG STE in MB or SB or occlusion of secondary SB (OR = 9.762, CI 3.273-29.12, p < 0.001). Conclusions:Intracoronary electrocardiography is a highly sensitive and specific method for determination of ischaemic regions and prediction of elevated troponin I. 944 INTRODUCTIONCoronary bifurcation lesions remain a major therapeutic challenge with high early and late complication rates. It has been shown that angiographically high grade ostial side branch (SB) stenosis is not flow limiting and may not cause ischaemia. Our studies with delayed gadolinium enhancement magnetic resonance imaging before and after bifurcation percutaneous coronary intervention (PCI) demonstrated that occurrence of angiographic stenosis of more than 70% in diameter is associated with periprocedural myonecrosis in the region of SB [1]. Moreover, the post-procedural myocardial injury after uncomplicated PCI is not uncommon [2-4] with a frequency of 5% to 30%. Although this is thought to have no clinical significance, clinical trials demonstrated an increased risk of adverse cardiac events in patients with periprocedural myonecrosis [5].The unipolar intracoronary electrocardiogram (icECG) recording from angioplasty guidewire represents local epicardial ECG and has been shown to be more sensitive and more reliable in detecting regional myocardial ischaemia during balloon inflation than standard ECG [6][7][8][9][10]. The icECG detects earlier ischaemia and the changes are more prominent than surface ECG. The wire...

Introduction There is an increasing number of young patients with acute coronary syndromes. The gold standard for diagnosis and treatment remains coronary angiography and primary percutaneous coronary intervention (PPCI). Especially in young individuals there are cases with large thrombus burden and almost none angiographically visible coronary atherosclerosis, which raises major concerns about the etiological cause for such events. Thrombophilia can lead to repeated and unexplained thrombus formation and that is why recently there is an increasing interest in the relationship between thrombophilia and acute coronary syndrome (ACS) in early age. Still there's no precise treatment algorithm. Purpose To diagnose and evaluate the frequency of thrombophilia in patients presenting with first ACS in young age and to alter future treatment in order to prevent further events and improve prognosis. Methods We evaluated all patients with first ACS from age&lt;40 for men and women &lt;50 in our hospital for 3 years. All patients were diagnosed and treated with PPCI. Complete family history was taken. We performed laboratory tests for the most frequent gene mutations, responsible for thrombophilia factor V Leiden, PAI –1 4G/5G, prothrombin G20210A, MTHFR - C677T, MTHFR A 1287C, MTHFR A 1298C and glycoprotein IIb/IIIa in all patients. Results 210 patients with ACS were admitted with 36 young patients (age men &lt;40 and women &lt;50). In all we performed screening for thrombophilia. 32 individuals (5 women and 27 men; mean age of 46) had a distinct genetic variation which can be attributed to thrombophilia. 85% of them had family history for ischemic heart disease. The conventional risk factors for coronary artery disease (CAD), including arterial hypertension, dyslipidemia, smoking, and diabetes were presented respectively in 43%, 57%, 43% and 3% in the group. The most often diseased artery was the left anterior descending artery (LAD). The genetic evaluation results were 20% homozygotes of pathogenic variation of factor V of Leiden, 7% heterozygotes of pathogenic form of factor V of Leiden 25% PAI 1 4G/5G homozygotes, 11% PAI 1 4G/5G heterozygotes, 13% prothrombin G20210A homozygotes and 2% prothrombin G20210A heterozygote. In 28% the index event was a repeated ACS and 4% has had a previous ischemic stroke. We then consulted all of them with haemathologist and altered further discharge treatment (in 100% new oral anticoagulants (NOAC) was added to dual antipatled therapy). In follow up at the first year 70% were left on aspirin 100mg and NOAC and 10% were considered high risk and were left on two NOAC. Conclusion Thrombophilia is an indipendant risk factor for myocardial infarction in young patients and should not be easily overlooked. In them screening for thrombophilia could be beneficial, especially for the follow-up treatment and improvement of the late prognosis. Such detection could prevent subsequent AMI. Funding Acknowledgement Type of funding source: Private hospital(s)

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