Relationship of left ventricular end-diastolic pressure with extent of myocardial ischemia, myocardial salvage and long-term outcome in patients with ST-segment elevation myocardial infarction.

Ndrepepa, Gjin; Cassese, Salvatore; Hashorva, Desard; Kufner, Sebastian; Xhepa, Erion; Hasimi, Endri; Fusaro, Massimiliano; Laugwitz, Karl-Ludwig; Schunkert, Heribert; Kastrati, Adnan

doi:10.1002/ccd.28098

2019

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Title:: Relationship of left ventricular end-diastolic pressure with extent of myocardial ischemia, myocardial salvage and long-term outcome in patients with ST-segment elevation myocardial infarction.
Document type:: Article; Journal Article
Author(s):: Ndrepepa, Gjin; Cassese, Salvatore; Hashorva, Desard; Kufner, Sebastian; Xhepa, Erion; Hasimi, Endri; Fusaro, Massimiliano; Laugwitz, Karl-Ludwig; Schunkert, Heribert; Kastrati, Adnan
Abstract:: 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.
Journal title abbreviation:: Catheter Cardiovasc Interv
Year:: 2019
Journal volume:: 93
Journal issue:: 5
Pages contribution:: 901-909
Fulltext / DOI:: doi:10.1002/ccd.28098
Pubmed ID:: http://view.ncbi.nlm.nih.gov/pubmed/30680881
Print-ISSN:: 1522-1946
TUM Institution:: I. Medizinische Klinik und Poliklinik (Kardiologie); Klinik für Herz- und Kreislauferkrankungen im Erwachsenenalter (Prof. Schunkert)
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mediaTUM Gesamtbestand Einrichtungen Schools TUM School of Medicine and Health Departments Clinical Medicine Lehr- und Forschungskooperationen mit den Kliniken und Instituten am Deutschen Herzzentrum Klinik für Herz- und Kreislauferkrankungen im Erwachsenenalter (DHM) (Prof. Schunkert)2019

mediaTUM Gesamtbestand Einrichtungen Schools TUM School of Medicine and Health Departments Clinical Medicine Klinik und Poliklinik für Innere Medizin I, Kardiologie (Prof. Laugwitz)2019