Why the study?
The association of left ventricular end-diastolic pressure (LVEDP) with myocardial salvage or long-term mortality in patients with STEMI had not been investigated.
Does elevated LVEDP predict increased 8-year cardiac mortality and reduced myocardial salvage in STEMI patients undergoing primary PCI?
Cohort (n=1,312)
Does elevated LVEDP predict increased 8-year cardiac mortality and reduced myocardial salvage in STEMI patients undergoing primary PCI?
In patients with STEMI undergoing primary PCI, elevated LVEDP is associated with greater myocardial ischemia, reduced myocardial salvage, and a higher risk of long-term cardiac mortality.
Answers are grounded in this paper and cite their sources.
May aid post-PCI risk stratification in STEMI; leaves open whether LVEDP measurement improves salvage or outcomes.
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.
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Ndrepepa et al. (2019) conducted a cohort in ST-segment elevation myocardial infarction (STEMI) (n=1,312). Left ventricular end-diastolic pressure (LVEDP) vs. Lower LVEDP tertiles was evaluated on 8-year cardiac mortality (HR 1.18, 95% CI 1.02-1.36, p=0.022).
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