Key result
In ACS patients with LVSD, the lowest pulmonary arterial capacitance tertile was associated with a higher risk of MACEs compared to the highest tertile (adjusted HR 2.35; 95% CI 1.25-4.42; p=0.008).
Why the study?
The prognostic value of right heart catheterization-derived hemodynamic indices in ACS patients with left ventricular systolic dysfunction without heart failure or shock remained uncertain.
Does lower pulmonary artery capacitance predict major adverse cardiovascular events in acute coronary syndrome patients with left ventricular systolic dysfunction?
Cohort (n=750)
Does lower pulmonary artery capacitance predict major adverse cardiovascular events in acute coronary syndrome patients with left ventricular systolic dysfunction?
Hazard Ratio: 2.35 (95% CI 1.25–4.42)
p-value: p=.008
Pulmonary artery capacitance derived from right heart catheterization provides independent long-term prognostic value in intermediate-risk ACS patients with left ventricular systolic dysfunction.
Objective Hemodynamic monitoring via right heart catheterization (RHC) is critical for managing acute coronary syndrome (ACS) patients with heart failure or cardiogenic shock. However, the prognostic value of RHC-derived hemodynamic indices in ACS patients with left ventricular systolic dysfunction (LVSD) but without heart failure or shock remains uncertain. Methods A retrospective cohort study included 1151 consecutive ACS patients who underwent RHC during hospitalization from 2007 to 2016. After excluding patients with shock, pulmonary edema, and severe valvular disease, 750 ACS patients with LVSD and ejection fraction < 50% were analyzed. Major adverse cardiovascular events (MACEs), including myocardial infarction and all-cause mortality, were followed for five years. Cox regression identified predictors of MACEs, adjusting for comorbidities, treatments, and hemodynamic indices, including pulmonary arterial capacitance (PAC). Results After a mean follow-up of 4.0 ± 1.7 years, 113 (15.1%) patients experienced MACEs. Multivariate analysis showed that independent predictors included prior stroke, calcified coronary lesions, and PAC. Patients in the lowest PAC tertile (≤2.89 ml/mmHg) had significantly higher risks of myocardial infarction (adjusted hazard ratio [HR]: 3.74; 95% confidence interval [CI]: 1.55–9.07; p = .003), all-cause mortality (adjusted HR: 2.55; 95% CI: 1.27–5.10; p = .008), and MACEs (adjusted HR: 2.35; 95% CI: 1.25–4.42; p = .008) compared to those in the highest tertile (>4.43 ml/mmHg). Discussion The study demonstrated that PAC is a notably strong hemodynamic parameter with independent long-term prognostic value in ACS patients with LVSD, who do not present with shock or heart failure. This is the first study to establish the prognostic significance of hemodynamic indices obtained from RHC in this population, extending the clinical relevance of RHC from high-risk to intermediate-risk ACS populations. Conclusions The use of RHC to assess hemodynamic indices, including PAC, during index hospitalization in this population may enhance long-term risk stratification and improve outcome prediction.
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Yeh et al. (2024) conducted a cohort in Acute coronary syndrome with left ventricular systolic dysfunction (n=750). Lowest pulmonary arterial capacitance (PAC) tertile (≤2.89 ml/mmHg) vs. Highest PAC tertile (>4.43 ml/mmHg) was evaluated on Major adverse cardiovascular events (MACEs) (HR 2.35, 95% CI 1.25-4.42, p=.008). In ACS patients with LVSD, the lowest pulmonary arterial capacitance tertile was associated with a higher risk of MACEs compared to the highest tertile (adjusted HR 2.35; 95% CI 1.25-4.42; p=0.008).
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