Prognostic role of on-line vectorcardiography as regards repeat revascularization after successful coronary angioplasty

This study evaluated the prognostic significance of continuous on-line vect orcardiography (VCG) during elective coronary angioplasty (percutaneous tra nsluminal coronary angioplasty, PTCA). Patients (n = 192, mean age 58 +/- 1 0), treated with elective and initially successful PTCA, were included. VCG monitoring was started before start of the PTCA procedure and was carried out during the entire procedure. ST vector magnitude (ST-VM) was monitored. A 6-month follow-up was obtained. Main outcome measures were the frequency of cardiac events and revascularization during follow-up. During follow-up , 1 patient died, 6 suffered a nonfatal myocardial infarction and 50 were r evascularized. Angiography revealed restenosis in 88% of the patients who h ad a revascularization. In the total patient group, the VCG predictor of re vascularization was the total ischemic time of all ST-VM episodes (p = 0.05 ). Clinical predictors of revascularization were diabetes mellitus (p < 0.0 1), a more severe type of lesion (type B; p < 0.01), percent post-PTCA sten osis (p < 0.05), nominal balloon size (p < 0.01), maximum balloon pressure (p < 0.05) and no stent implanted (p < 0.001). In a multivariate analysis a ll the above significant univariate variables of revascularization were ent ered. Total ischemic time of ST-VM (p < 0.01) was the best variable giving independent prognostic information. In the nonstent group, total ischemic t ime of SI-VM (p < 0.01) was the only independent predictor of a further rev ascularization. In conclusion, VCG monitoring during elective PTCA gives on -line information that identifies patients at an increased risk of a revasc ularization during 6 months after the initial procedure. Copyright (C) 2000 S. Karger AG, Basel.