Coronary Ischemia Clinical Trial
Official title:
Pharmacologic Treatment of Myocardial Ischemia Detected by Intracoronary ECG
After PCI searching for target lesion ischemia with intracoronary ECG will be performed and if found it will be treated pharmacologically
The study will include patients with coronary lesions and PCI. It will include patients with
stable or unstable angina, without elevated hs-TnT. PCI will be performed and monitoring of
intracoronary ST elevation. Any dissection or acute vessel closure will be promptly treated
with balloon or stenting.
Although there could be good angiographic result sometimes ischemia could be detected in the
treated region by means of intracoronary ECG ST elevation above 1mm.
This study aims to tackle this issue with randomization of the patients into three possible
treatments - intracoronary adenosine, IIb/IIIa inhibitors or nitroglycerine alone -
intracoronary ST segment will be searched for reverse or residual ischemia after the
pharmacologic bolus.
The intracoronary electrocardiography (i.c. ECG) is a very sensitive method for ischemia
detection. The i.c. ECG reacts earlier on ischemia; the changes are much more prominent and
easy to register. The wire tip could be positioned directly in different regions and thus to
"map" regional ischemia. In most of the studies and from our own observations became evident
that when surface ECG do not react the i.c. ECG demonstrates significant changes in
ST-segment and QRS complex. Moreover, the registration of i.c. ECG is very cheap and needs
only an adapter connecting coronary wire end and ECG. An i.c. ECG also can differentiate
residual ischemic changes in distal main vessel and side branch as sources of prolonged
ischemia, respectively - source of periprocedural myonecrosis.
Once good angiographic result is obtained after stenting there could be different reasons for
ischemia in the treated region - microembolic debris or coronary microvascular spasm.
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