Twelve-lead electrocardiographic evaluation of ischemia during percutaneous transluminal coronary angioplasty and its correlation with acute reocclusion.

The sensitivity of the surface 12-lead electrocardiogram and that of standard (limb-lead) monitoring for the detection of ischemia during percutaneous transluminal coronary angioplasty were compared in 115 patients. The purpose was to identify the electrocardiographic leads that provide the most sensitive indicators of coronary ischemia during percutaneous transaluminal coronary angioplasty and to evaluate the "ischemic fingerprint" that is obtained with 12-lead electrocardiogram during balloon inflation as a predictor of abrupt reocclusion after successful percutaneous transaluminal coronary angioplasty procedures. During balloon inflations of 30 seconds, ischemia was detected in 61 of 145 vessels (42%) by limb-lead monitoring alone versus 130 of 145 vessels (90%) by 12-lead electrocardiography (p less than or equal to 0.001). In the nine patients (7.8%) who experienced abrupt reocclusion within 24 hours, the electrocardiogram during chest pain after percutaneous transaluminal coronary angioplasty was identical to that obtained during percutaneous transaluminal coronary angioplasty ("ischemic fingerprint"). None of the six patients who had chest pain after percutaneous transaluminal coronary angioplasty without evidence of abrupt reocclusion reproduced their ischemic fingerprint. The suggested optimal leads for monitoring ischemia are as follows: left anterior descending coronary artery, V2, and V3; circumflex artery, V2, and V3; and right coronary artery, III and aVF.