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Association of left ventricular end‐diastolic pressure with mortality in patients undergoing percutaneous coronary intervention for acute coronary syndromes
Author(s) -
Leistner David M.,
Dietrich Steven,
Erbay Aslihan,
Steiner Julia,
Abdelwahed Youssef,
Siegrist Patrick T.,
Schindler Matthias,
Skurk Carsten,
Haghikia Arash,
Sinning David,
Riedel Matthias,
Landmesser Ulf,
Stähli Barbara E.
Publication year - 2020
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.28839
Subject(s) - medicine , preload , cardiology , percutaneous coronary intervention , conventional pci , hazard ratio , myocardial infarction , acute coronary syndrome , ventricular pressure , confidence interval , hemodynamics
Objectives This study sought to investigate the relation between left ventricular end‐diastolic pressure (LVEDP) and outcomes in patients undergoing percutaneous coronary intervention (PCI) for acute coronary syndromes (ACS). Background Risk stratification in ACS patients is important. Data on the role of LVEDP in the prognostication of ACS patients are scarce. Methods A total of 1,410 patients undergoing PCI for ACS and with available data on LVEDP were divided according to LVEDP tertiles (lowest tertile: ≤13 mmHg, intermediate tertile: 14–20 mmHg, and highest tertile: >20 mmHg). The primary endpoint was all‐cause mortality at a median follow‐up of 246 [28–848] days. Results Median LVEDP was 16 (11–22) mmHg. All‐cause mortality was 2.8%, 4.5%, and 15.0% in the lowest, the intermediate, and the highest LVEDP tertile groups ( p < .001), respectively. Belonging to the highest LVEDP tertile was associated with an increased risk of all‐cause mortality (adjusted hazard ratio [HR] = 2.66, 95% confidence interval [CI] [1.30, 5.47], p = .008). By receiver operating characteristic curve analysis, the optimal cut‐off value for predicting all‐cause mortality was 20 mmHg (sensitivity 68.3%, specificity 72.5%). There was no differential effect of LVEDP on mortality in patients with and without LV dysfunction (interaction p = .23) or ST‐elevation myocardial infarction as index ACS event (interaction p = .86). Conclusions In patients undergoing PCI for ACS, LVEDP was independently related with mortality. Hence, LVEDP should be incorporated into early risk stratification and clinical decision making of ACS patients.