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Correlation of infarct size with invasive hemodynamics in patients with ST‐elevation myocardial infarction
Author(s) -
Goins Allie E.,
Rayson Robert,
Caughey Melissa C.,
Sola Michael,
Venkatesh Kiran,
Dai Xuming,
Yeung Michael,
Stouffer George A.
Publication year - 2018
Publication title -
catheterization and cardiovascular interventions
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.988
H-Index - 116
eISSN - 1522-726X
pISSN - 1522-1946
DOI - 10.1002/ccd.27625
Subject(s) - preload , medicine , cardiology , myocardial infarction , ejection fraction , hemodynamics , timi , percutaneous coronary intervention , infarction , troponin , heart failure
Objectives To identify invasive hemodynamic parameters that correlate with infarction size in patients with ST‐elevation myocardial infarction (STEMI). Background Invasive hemodynamics obtained during primary percutaneous coronary intervention (PPCI) are predictive of mortality in STEMI, but which parameters correlate best with the size of the infarction are unknown. Methods This is a single‐center study of 405 adult patients with STEMI who had left ventricular end‐diastolic pressure (LVEDP) measured during PPCI. Size of infarction was estimated by peak troponin I level and ejection fraction (LVEF) determined by echocardiography. Results The average (±SD) age was 61 ± 14 years, TIMI STEMI risk score was 3.5 ± 2.7 and Grace score was 157 ± 42. Hemodynamic parameters that correlated best with EF were LVEDP ( r = −0.40), PP ( r = 0.24), and SBP/LVEDP ratio ( r = 0.22) and with peak troponin were SBP/LVEDP ratio ( r = −0.41), LVEDP ( r = 0.31), and PP ( r = −0.29). SBP/LVEDP (AUC = 0.76) and SBP (AUC = 0.77) had a stronger association with in‐hospital mortality than did LVEDP (AUC = 0.66) or PP (AUC = 0.64). Door‐to‐balloon time did not affect the correlations between hemodynamic parameters and infarct size. Conclusions In this sample of 405 patients undergoing PPCI, SBP/LVEDP ratio had the strongest correlation with peak troponin levels and LVEDP with EF, whereas SBP/LVEDP and SBP had a strong association with in‐hospital mortality. These results suggest that measurement of LVEDP as well as SBP may help risk stratify patients during PPCI.