Impact of Postprocedural Left Ventricular End-Diastolic Pressure on Microvascular Perfusion and Myocardial Function after Primary Percutaneous Coronary Intervention in Acute Myocardial Infarction

Q: What are the key findings of this study?

Elevated postprocedural LVEDP (>19 mmHg) increased the odds of poor myocardial perfusion (TMP grade <3) after primary PCI in STEMI patients (72.4% vs 34.5%; OR 4.98, 95% CI 2.91-8.54, p<0.001).

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Acute ST-elevation myocardial infarction (STEMI) (n=250). Intervention: Elevated postprocedural left ventricular end-diastolic pressure (LVEDP >19 mmHg) vs. Low postprocedural LVEDP (≤19 mmHg). Primary outcome: Poor TIMI Myocardial Perfusion grade (TMP <3) (OR 4.98, 95% CI 2.91-8.54, p=<0.001).

Q: What does this research mean for the field?

Elevated postprocedural left ventricular end-diastolic pressure independently predicts impaired myocardial microvascular perfusion, incomplete ST-segment resolution, and reduced left ventricular ejection fraction following primary PCI in STEMI patients. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Adnan Ilyas Malik; Tariq Abbas; Hassaan Tariq; Adiba Ashfaq

doi:10.47144/phj.v58is3.3349

December 30, 2025Pakistan Heart JournalOpen Access

Impact of Postprocedural Left Ventricular End-Diastolic Pressure on Microvascular Perfusion and Myocardial Function after Primary Percutaneous Coronary Intervention in Acute Myocardial Infarction

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Key result

Elevated post-PCI LVEDP is linked to ~5-fold higher odds of poor myocardial perfusion in STEMI.

OR 4.98
95% CI 2.91-8.54
P<0.001
n=250

Why the study?

The impact of postprocedural LVEDP on microvascular reperfusion indices and ventricular function following primary PCI in patients with acute STEMI needed to be determined.

Does elevated postprocedural left ventricular end-diastolic pressure (>19 mmHg) predict impaired microvascular perfusion, incomplete ST-segment resolution, and reduced left ventricular ejection fraction at 1 month in patients with first STEMI achieving TIMI-3 flow after primary PCI?

Key Points

To determine the impact of postprocedural left ventricular end-diastolic pressure (LVEDP) on microvascular reperfusion indices and left ventricular systolic function following primary percutaneous coronary intervention (PCI) in patients with ST-elevation myocardial infarction (STEMI).
Prospective cohort study of 250 consecutive STEMI patients who achieved TIMI-3 epicardial flow after primary PCI, categorized by postprocedural LVEDP into high (>19 mmHg, n=134) and low (≤19 mmHg, n=116) groups.
Outcomes evaluated at baseline and one-month follow-up included TIMI myocardial perfusion (TMP) grade, ST-segment resolution (>50%), and left ventricular ejection fraction (LVEF).
Multivariable logistic regression was used to evaluate associations while adjusting for age, sex, infarct location, and time to PCI.
Patients with LVEDP >19 mmHg had significantly higher rates of poor myocardial perfusion (TMP <3: 72.4% vs. 34.5%, p < 0.001) and incomplete ST-segment resolution (<50%: 47.1% vs. 28.4%, p = 0.003) than those with LVEDP ≤19 mmHg.
At one month, reduced LVEF (<40%) occurred in 57.5% of the high LVEDP group compared to 31.9% of the low LVEDP group (mean LVEF: 40.2 ± 7.6% vs. 45.5 ± 6.9%, p < 0.001).
Each 1 mmHg increase in LVEDP independently predicted poor TMP grade (aOR 1.22; 95% CI 1.13–1.32; p < 0.001), incomplete ST-segment resolution (aOR 1.11; 95% CI 1.05–1.18; p = 0.001), and reduced LVEF (aOR 1.21; 95% CI 1.11–1.32; p < 0.001).

Study Design

Type

Cohort (n=250)

Blinding

Blinded outcome assessment

Multicenter

No

Structured PICO

Does elevated postprocedural left ventricular end-diastolic pressure (>19 mmHg) predict impaired microvascular perfusion, incomplete ST-segment resolution, and reduced left ventricular ejection fraction at 1 month in patients with first STEMI achieving TIMI-3 flow after primary PCI?

P

Population

250 adults (mean age 54.8 years, 16.8% female) presenting with their first acute STEMI and achieving TIMI-3 epicardial flow after primary PCI, free of prior MI or cardiogenic shock, followed for 1 month.

E

Exposure

High postprocedural left ventricular end-diastolic pressure (LVEDP >19 mmHg, n=134) measured at end-expiration immediately following primary PCI using a 6-Fr Judkins Right (JR4) catheter.

C

Comparator

Low postprocedural left ventricular end-diastolic pressure (LVEDP ≤19 mmHg, n=116) measured immediately following primary PCI.

O

Outcome

Myocardial perfusion assessed by TIMI Myocardial Perfusion (TMP) grade (<3 indicating poor perfusion), electrical recovery determined by ST-segment resolution (≥50% within 90 minutes of PCI), and left ventricular systolic function measured by left ventricular ejection fraction (LVEF <40%) at one-month follow-up via Simpson's biplane echocardiography (all assessed by a single blinded cardiologist).surrogate

Main Result

Odds Ratio: 4.98 (95% CI 2.91–8.54)

Absolute Event Rate: 72.4% vs 34.5%

p-value: p=<0.001

Limitations

Single-center study limiting generalizability to other populations or healthcare settings
Residual confounding cannot be entirely excluded despite multivariable adjustment
Microvascular perfusion was evaluated using TMP grade and ST-segment resolution rather than advanced imaging modalities like cardiac MRI
Intra-observer variability was not formally assessed as all assessments were performed by a single cardiologist
Short follow-up duration limited to one month
Residual confounding cannot be entirely excluded despite statistical adjustment for major confounders
Microvascular perfusion was evaluated using TMP grade and ST-segment resolution, which are less precise than advanced imaging modalities such as cardiac MRI
Intra-observer variability was not formally assessed as all analyses were performed by a single cardiologist
Follow-up was limited to one month, preventing evaluation of long-term prognostic implications

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Implication

Routine intra-procedural measurement of LVEDP after successful primary PCI in STEMI patients provides an inexpensive, immediate hemodynamic marker to identify those at high risk for microvascular dysfunction and reduced 1-month left ventricular ejection fraction despite achieving TIMI-3 flow.

Abstract

Objectives: To determine the impact of left ventricular end-diastolic pressure (LVEDP) on microvascular reperfusion indices and ventricular function following primary percutaneous coronary intervention (PCI) in patients with acute ST-elevation myocardial infarction (STEMI). Methodology: This prospective cohort study included 250 consecutive STEMI patients who underwent primary PCI with successful restoration of TIMI-3 epicardial flow. Postprocedural LVEDP was measured and patients were categorized into two groups: high LVEDP (>19 mmHg) and low LVEDP (≤19 mmHg). Study outcomes included TIMI myocardial perfusion (TMP) grade, ST-segment resolution (>50%), and left ventricular ejection fraction (LVEF) at one-month follow-up. Multivariable logistic regression was used to evaluate associations while adjusting for age, sex, infarct location, and time to PCI. Results: The mean age was 54.8 ± 11.8 years, and 83% were male. Elevated LVEDP independently predicted poorer TMP grade (aOR 1.22; 95% CI 1.13–1.32; p < 0.001), incomplete ST-segment resolution (aOR 1.11; 95% CI 1.05–1.18; p = 0.001), and reduced LVEF (<40%) (aOR 1.21; 95% CI 1.11–1.32; p < 0.001). Older age and anterior wall infarction were additional predictors of reduced systolic recovery. Conclusion: Elevated LVEDP independently predicts impaired myocardial reperfusion, incomplete electrical recovery, and reduced left ventricular systolic function after primary PCI in STEMI patients. Routine intra-procedural LVEDP measurement may help identify patients at risk for microvascular dysfunction and guide targeted post-PCI management.

Discussion

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Cite This Study

Malik et al. (2025) conducted a cohort in Acute ST-elevation myocardial infarction (STEMI) (n=250). Elevated postprocedural left ventricular end-diastolic pressure (LVEDP >19 mmHg) vs. Low postprocedural LVEDP (≤19 mmHg) was evaluated on Poor TIMI Myocardial Perfusion grade (TMP <3) (OR 4.98, 95% CI 2.91-8.54, p=<0.001). Elevated postprocedural LVEDP (>19 mmHg) increased the odds of poor myocardial perfusion (TMP grade <3) after primary PCI in STEMI patients (72.4% vs 34.5%; OR 4.98, 95% CI 2.91-8.54, p<0.001).

synapsesocial.com/papers/6aefaf2d5b177124996fa0ff https://doi.org/10.47144/phj.v58is3.3349

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Impact of Postprocedural Left Ventricular End-Diastolic Pressure on Microvascular Perfusion and Myocardial Function after Primary Percutaneous Coronary Intervention in Acute Myocardial Infarction

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Impact of Postprocedural Left Ventricular End-Diastolic Pressure on Microvascular Perfusion and Myocardial Function after Primary Percutaneous Coronary Intervention in Acute Myocardial Infarction

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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