What is the clinical evidence from this study?

Study design: Observational. Population: ST-segment elevation myocardial infarction (STEMI) classified as Killip classes 3-4 (n=145). Intervention: Pulmonary arterial elastance (PaE) measurement vs. Other hemodynamic indices (CPO, PAPI, PVR). Primary outcome: In-hospital all-cause death (OR 2.49, 95% CI 1.02-6.13, p=0.046).

What question did this study set out to answer?

This research aims to determine the prognostic value of pulmonary arterial elastance in patients with STEMI classified as Killip classes 3 and 4.

April 24, 2026Circulation Reports0 citationsOpen Access

Prognostic Utility of Pulmonary Arterial Elastance in Patients With ST-Segment Elevation Myocardial Infarction Classified as Killip Classes 3–4

SKShotaro Kawai KNKensaku Nishihira TKToshiyuki Kimura

Key Result

Higher pulmonary arterial elastance independently predicted in-hospital death in patients with STEMI classified as Killip classes 3-4 (OR 2.49).

Key Points

This research aims to determine the prognostic value of pulmonary arterial elastance in patients with STEMI classified as Killip classes 3 and 4.
Conducted a hemodynamic assessment in STEMI patients
Classified patients according to Killip classes 3 and 4
The prognostic significance of pulmonary arterial elastance remains unclear
Invasive hemodynamic assessment is critical in these patient categories

Study Design

Type

Observational (n=145)

Multicenter

Structured PICO

Does pulmonary arterial elastance (PaE) predict in-hospital death in patients with STEMI classified as Killip classes 3-4?

Population

145 patients with ST-segment elevation myocardial infarction (STEMI) classified as Killip classes 3-4 who underwent primary percutaneous coronary intervention (PCI), median age 79, 30.9% female, single-center in Japan. Excluded: Killip class 1-2, patients who received Impella or extracorporeal membrane oxygenation (ECMO) support, and unavailable pulmonary artery catheter (PAC) data.

Intervention

Measurement of pulmonary arterial elastance (PaE) via pulmonary artery catheter (PAC) immediately following primary PCI. PaE calculated as systolic pulmonary artery pressure divided by stroke volume.

Outcome

In-hospital all-cause deathhard clinical

In patients with STEMI complicated by advanced heart failure or cardiogenic shock, pulmonary arterial elastance measured immediately after primary PCI is a strong, independent predictor of in-hospital mortality.

Main Result

Effect estimate: OR 2.49 (95% CI 1.02-6.13)

p-value: p=0.046

Limitations

Retrospective, single-center analysis with a limited sample size and a small number of events
Selection bias and unmeasured confounding could not be entirely excluded
Treatment strategies were heterogeneous as it was not a randomized controlled trial
Stroke volume was primarily derived from thermodilution, which can be influenced by tricuspid regurgitation
Only assessed in-hospital death, so longer-term outcomes remain to be defined
Focused exclusively on patients with STEMI classified as Killip classes 3-4

Abstract

Background: Invasive hemodynamic assessment is critical in patients with ST-segment elevation myocardial infarction (STEMI) classified as Killip classes 3–4. However, the prognostic utility of pulmonary arterial elastance (PaE) remains unclear.

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Cite This Study

Kawai et al. (Tue,) conducted a observational in ST-segment elevation myocardial infarction (STEMI) classified as Killip classes 3-4 (n=145). Pulmonary arterial elastance (PaE) measurement vs. Other hemodynamic indices (CPO, PAPI, PVR) was evaluated on In-hospital all-cause death (OR 2.49, 95% CI 1.02-6.13, p=0.046). Higher pulmonary arterial elastance independently predicted in-hospital death in patients with STEMI classified as Killip classes 3-4 (OR 2.49).

synapsesocial.com/papers/69eb084f553a5433e34b35ae https://doi.org/https://doi.org/10.1253/circrep.cr-26-0053

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