Abstract 13779: J Wave Augmentation During CAG is Related to VF in the Acute Phase of STEMI

Introductions and Hypothesis: Myocardial ischemia induced by contrast medium during coronary angiography (CAG) is associated with local conduction delay and J wave manifestation. However, whether J wave manifestation during CAG can predict ventricular fibrillation (VF) in the acute phase of ST-elevation myocardial infarction (STEMI) is unclear.

Methods: Among 420 consecutive patients with STEMI who underwent emergent percutaneous coronary intervention, 141 patients (male, n=116; age, 65±10 years) who underwent CAG in the absence of significant coronary artery stenosis were included in this study. Patients were divided into two groups based on the development (n=17) or non-development (n=124) of VF within 48 hours after STEMI. Electrocardiograms recorded during CAG in the absence of significant coronary artery stenosis were analyzed in all subjects.

Results: The frequency of J wave (≥0.1 mV) at baseline was similar between the VF (18%) and non-VF (8%) groups. However, the frequency of J wave augmentation >0.1 mV above baseline during CAG was higher in the VF group than in the non-VF-group (47% vs. 8%; P<0.01). The percentage of Killip class ≥3 was higher in the VF group than in the non-VF group, but there were no significant differences between the two groups in coronary risk factors, time from onset to transport to the hospital, or peak CK/CK-MB values. In a multivariate analysis, J wave augmentation during CAG was an independent factor in the occurrence of VF in the acute phase of STEMI.

Conclusions: J wave augmentation during CAG was associated with VF within 48 hours after the onset of STEMI and may be useful for risk stratification of STEMI.