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Relationship of left ventricular end‐diastolic pressure with extent of myocardial ischemia, myocardial salvage and long‐term outcome in patients with ST‐segment elevation myocardial infarction
Author(s) -
Ndrepepa Gjin,
Cassese Salvatore,
Hashorva Desard,
Kufner Sebastian,
Xhepa Erion,
Hasimi Endri,
Fusaro Massimiliano,
Laugwitz KarlLudwig,
Schunkert Heribert,
Kastrati Adnan
Publication year - 2019
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.28098
Subject(s) - preload , medicine , cardiology , myocardial infarction , percutaneous coronary intervention , conventional pci , hazard ratio , ventricular pressure , confidence interval , hemodynamics
Objectives We aimed to assess the association of left ventricular end‐diastolic pressure (LVEDP) with myocardial salvage and long‐term mortality in ST‐segment elevation myocardial infarction (STEMI) patients undergoing primary percutaneous coronary intervention (PCI). Background The association of LVEDP with myocardial salvage or long‐term mortality in patients with STEMI has not been investigated. Methods This study included 1,312 patients with STEMI undergoing primary PCI between 2002 and 2007. LVEDP was measured at the time of intervention. Patients were divided into three groups: a group with LVEDP in the 1st tertile (LVEDP, 4–19 mmHg; n = 496), a group with LVEDP in the 2nd tertile (LVEDP >19–24 mmHg; n = 410) and a group with LVEDP in the 3rd tertile (LVEDP >24–45 mmHg; n = 406). The primary outcome was 8‐year cardiac mortality. Results The primary outcome (cardiac deaths) occurred in 114 patients. Deaths occurred in 26 (7.9%), 36 (11.5%), and 52 (16.4%) patients with LVEDP in the 1st to 3rd tertiles, respectively (adjusted hazard ratio = 1.18, 95% confidence interval 1.02–1.36, P = 0.022, for 5 mmHg increment in the LVEDP values). LVEDP correlated with the extent of myocardial ischemia (R = 0.351; P < 0.001). In patients with LVEDP in the 1st to 3rd tertiles, the salvage index (proportion of initial area at risk salvaged) was 0.53 [0.27–0.84], 0.53 [0.28–0.80], and 0.43 [0.18–0.75], respectively ( P = 0.012). After adjustment, LVEDP correlated inversely with myocardial salvage ( P < 0.001). Conclusions In patients with STEMI, elevated LVEDP correlated with the extent of myocardial ischemia, reduced myocardial salvage and increased risk of 8‐year cardiac mortality.