The Study Of Intracoronary Electrocardiogram In Evaluation Of Percutaneous Coronary Intervention Guided By Fractional Flow Reserve

Objective:Based on the percutaneous coronary intervention under the guidance of fraction flow reserve,the value of intracoronary electrocardiogram in the diagnosis of regional myocardial ischemia in single-vessel critical lesions was evaluated.Methods:According to the entry and discharge criteria,patients who underwent coronary angiography in our hospital from January 2019 to December 2020,and rely on the quantitative coronary angiography,indicating a single vessel critical lesion(about40-70% of the diameter of stenosis).Taking FFR as the gold standard,the sensitivity,specificity,positive predictive value and negative predictive value of IC-ECG were calculated,and the diagnostic accuracy of IC-ECG in predicting significant functional stenosis was evaluated based on FFR results.The correlation between FFR and the absolute value of ST segment offset of IC-ECG was analyzed,and the ST segment of IC-ECG was divided into change group(group A)and non-change group(group B),and the difference of FFR level between the two groups was analyzed.Results:1.The absolute value of IC-ECG ST segment offset has a sensitivity of 100%,a specificity of 69.23%,a positive predictive value of 85.19%,and a negative predictive value of 100% for single-vessel critical lesions.2.Based on the results of FFR,the accuracy of IC-ECG in predicting significant functional stenosis.If FFR ≤ 0.80 indicates functional stenosis,the diagnostic accuracy is 0.88(P<0.001,95%CI 0.75-1.000),and the Jordan index is 0.692,the corresponding best truncation value is 0.075 m V;If FFR ≤ 0.75 indicates functional significant stenosis,the diagnostic accuracy is 0.81(P=0.002,95%CI 0.67-0.95),Jordan index = 0.475,the corresponding best truncation value is 0.125 m V.3.There is a negative correlation between FFR and the absolute value of IC-ECG ST segment offset,that is,the smaller the FFR value is,the larger the absolute value of ST segment offset is(r =-0.652,P < 0.001).4.The IC-ECG ST segment was divided into change group(group A)and non-change group(group B).There was significant difference in FFR between the two groups(group A vs group B:0.75±0.10 vs 0.91±0.05,group 0.002).Conclusion:1.Coronary electrocardiogram has a certain ability to predict significant functional stenosis,which provides a supplementary strategy for evaluating the significance of physiological stenosis of critical lesions.2.In this study,it is suggested that the ST segment offset ≥ 0.1m V of coronary electrocardiogram should be used as the diagnostic criterion of myocardial ischemia.