THE IMPACT OF AUTOPERFUSION ON QUANTITATIVE ELECTROCARDIOGRAPHIC PARAMETERS OF ISCHEMIA SEVERITY, EXTENT, AND BURDEN DURING SALVAGE OF ELECTIVE CORONARY ANGIOPLASTY

Long angioplasty inflations have been reported using an autoperfusion system that delivers oxygenated blood distal to the balloon segment. T he safety and efficacy of this system has been demonstrated in anatomi cally selected patients. The clinical use, however, is frequently to s tabilize intimal dissection in unselected patients. We reviewed 12-lea d continuous electrocardiographic (ECG) recordings in 40 patients in w hom prolonged salvage with autoperfusion was attempted. Sub-optimal re sults were stabilized in 36 of 40, while 4 patients had urgent bypass. The presence of ischemia, as greater than or equal to 100 uV ST eleva tion over the 12 lead ECG, and the total ST deviation over all leads o ver the entire inflation period (total ischemic ''burden'') were compa red within each patient between the longest standard balloon and autop erfusion inflations. Median duration of inflation was 3.03 min. with b alloon vs. 15.6 min. with autoperfusion (p < 0.00002). Of the 40 patie nts, 35 (87%) had ECG ischemia with balloon vs. 18 (45%) with autoperf usion (p < .00002). Median severity of peak ST deviation was 321 uV wi th balloon vs. 132 uV with autoperfusion (p=0.0001). Median extent of ST elevation was 3 leads with balloon vs. 0 leads with autoperfusion ( p=0.0001). Median total ischemic burden was similar with balloon (1173 uVmin) and autoperfusion (1083 uVmin, NS) despite the fivefold longer inflation duration with autoperfusion. Thus, in patients selected by clinical necessity rather than optimal anatomy, severity and extent of ST elevation were significantly reduced, although not entirely elimin ated, by autoperfusion.