Impact of Left Ventricular End-Diastolic Pressure on Percutaneous Coronary Intervention Outcomes

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Chronic and acute coronary syndromes (n=17179). Intervention: Elevated left ventricular end-diastolic pressure (>14 mm Hg) vs. Normal left ventricular end-diastolic pressure (≤14 mm Hg). Primary outcome: All-cause mortality at 1-year post-PCI.

Q: What does this research mean for the field?

Elevated left ventricular end-diastolic pressure is associated with increased 1-year all-cause mortality in patients undergoing percutaneous coronary intervention for chronic coronary syndrome or acute coronary syndrome. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Matthew Siano; Yash Jobanputra; Angelo Oliva; Samantha Sartori; Kenneth J. Smith; Harleen Kaur; Joseph Sweeny; George Dangas; R. Mehran; Annapoorna Kini; Samin K. Sharma

doi:10.1016/j.jscai.2025.104017

November 18, 2025Journal of the Society for Cardiovascular Angiography & InterventionsOpen Access

Impact of Left Ventricular End-Diastolic Pressure on Percutaneous Coronary Intervention Outcomes

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Key result

Elevated LVEDP linked to higher 1-year mortality after percutaneous coronary intervention.

n=17,179

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Why the study?

While LVEDP is associated with adverse outcomes following PCI for ACS, its impact on outcomes across both chronic coronary syndrome and ACS remained to be evaluated.

Does elevated left ventricular end-diastolic pressure increase mortality and major adverse cardiovascular events in patients with chronic or acute coronary syndromes undergoing PCI?

Study Design

Type

Cohort (n=17,179)

Multicenter

No

Structured PICO

Does elevated left ventricular end-diastolic pressure increase mortality and major adverse cardiovascular events in patients with chronic or acute coronary syndromes undergoing PCI?

P

Population

17,179 patients with chronic or acute coronary syndromes undergoing percutaneous coronary intervention, followed for 1 year to evaluate the prognostic impact of left ventricular end-diastolic pressure.

E

Exposure

Elevated left ventricular end-diastolic pressure (LVEDP 15 to 20 mm Hg or >20 mm Hg) measured during coronary angiography prior to left ventriculography or intervention.

C

Comparator

Normal left ventricular end-diastolic pressure (LVEDP ≤14 mm Hg).

O

Outcome

All-cause mortality at 1-year post-PCI.hard clinical

Limitations

Single-center, observational retrospective design with potential unmeasured confounding.
Differences in discharge medical therapy between groups were not controlled for in the primary analysis.
LVEDP measurements were not verified by a core laboratory, introducing potential measurement error.
Baseline characteristics of patients without recorded LVEDP who were excluded are unavailable.
10.3% of the patient population was lost to follow-up.
Periprocedural administration of medications affecting LVEDP was not recorded.
LVEDP was measured by the interventional cardiologist performing the procedure without core laboratory adjudication.
The analysis did not adjust for differences in discharge antiplatelet therapy, which was prescribed significantly less often in patients with LVEDP >20 mm Hg.
Imbalanced distribution of LVEDP values with only a small proportion exhibiting markedly elevated LVEDP (>20 mm Hg).

Implication

Elevated left ventricular end-diastolic pressure measured during PCI provides independent long-term prognostic value, identifying patients at increased risk for 1-year mortality, MACE, and bleeding.

Abstract

Background: Left ventricular end-diastolic pressure (LVEDP) is associated with adverse outcomes following percutaneous coronary intervention (PCI) for acute coronary syndrome (ACS). We evaluated the impact of LVEDP on outcomes in patients with chronic coronary syndrome or ACS undergoing PCI. Methods: Consecutive patients undergoing PCI between 2014 and 2021 were included. Patients with LVEDP ≤14 mm Hg were compared to those with LVEDP 15 to 20 mm Hg and LVEDP >20 mm Hg. The primary outcome was all-cause mortality at 1 year. A supplemental analysis was conducted in patients with LVEDP >20 mm Hg according to left ventricular ejection fraction. Results: = .004). Conclusions: In a population of patients with chronic coronary syndrome and ACS undergoing PCI, elevated LVEDP was associated with increased mortality at 1 year. Systolic dysfunction was associated with higher mortality in patients with LVEDP >20 mm Hg.

Discussion

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Cite This Study

Siano et al. (2025) conducted a cohort in Chronic and acute coronary syndromes (n=17,179). Elevated left ventricular end-diastolic pressure (>14 mm Hg) vs. Normal left ventricular end-diastolic pressure (≤14 mm Hg) was evaluated on All-cause mortality at 1-year post-PCI. Elevated left ventricular end-diastolic pressure (>14 mm Hg) was significantly associated with increased all-cause mortality at 1 year compared to normal pressure in patients undergoing percutaneous coronary intervention.

synapsesocial.com/papers/6a0ee2531c5e2d2319fa07f4 https://doi.org/10.1016/j.jscai.2025.104017

Topics

Percutaneous coronary intervention

Coronary artery disease

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Impact of Left Ventricular End-Diastolic Pressure on Percutaneous Coronary Intervention Outcomes

Figures

Study Design

Structured PICO

Limitations

Implication

Abstract

Discussion

Cite This Study

Topics

Impact of Left Ventricular End-Diastolic Pressure on Percutaneous Coronary Intervention Outcomes

Figures

Study Design

Structured PICO

Limitations

Implication

Abstract

Discussion

Cite This Study

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Topics

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