Correlation of infarct size with invasive hemodynamics in patients with ST‐elevation myocardial infarction

Goins, Allie; Rayson, Robert; Caughey, Melissa C.; Sola, Michael; Venkatesh, Kiran; Dai, Xuming; Stouffer, George A.

doi:10.1002/ccd.27625

Cited by 11 publications

(11 citation statements)

References 33 publications

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“…Our study showed that elevated LVEDP was associated with reduced myocardial salvage and larger infarct size after primary PCI. A correlation between LVEDP and peak troponin has been reported . However, our study is the first to show a significant but inverse correlation between LVEDP and the amount of myocardial salvage by primary PCI in patients with STEMI.…”

Section: Discussionmentioning

confidence: 99%

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

Cassese

Hashorva

et al. 2019

Cathet Cardio Intervent

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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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Section: Discussionmentioning

confidence: 99%

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

Cassese

Hashorva

et al. 2019

Cathet Cardio Intervent

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“…14,15 SBP/LVEDP ratio and CPP have been shown to be responsible for adverse left ventricular remodelling in patients with coronary artery disease. 16,17 Given the small sample size and short treatment duration no significant difference in peak troponin level (as a surrogate for infarct size) has been demonstrated in our cohort.…”

Section: Discussionmentioning

confidence: 83%

Targeting elevated left ventricular end-diastolic pressure following primary percutaneous coronary intervention for ST-segment elevation myocardial infarction – a phase one safety and feasibility study

Khan

Davies

Whitehead

et al. 2020

European Heart Journal. Acute Cardiovascular Care

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Introduction: Elevated left ventricular end diastolic pressure (LVEDP) is an independent predictor of mortality and heart failure in patients with ST-segment elevation myocardial infarction (STEMI). Whether lowering elevated LVEDP improves outcomes remains unknown. Methods: This non-randomized, single blinded study with prospective enrolment and sequential group allocation recruited patients undergoing primary percutaneous coronary intervention for STEMI with LVEDP ⩾ 20 mmHg measured immediately after primary percutaneous coronary intervention. The intervention arm ( n=10) received furosemide 40 mg intravenous bolus plus escalating doses of glyceryl trinitrate (100 µg per min to a maximum of 1000 µg) during simultaneous measurement of LVEDP. The control group ( n=10) received corresponding normal saline boluses with simultaneous measurement of LVEDP (10 readings over 10 min). Efficacy endpoints were final LVEDP achieved, and the dose of glyceryl trinitrate needed to reduce LVEDP by ⩾ 20%. Safety endpoint was symptomatic hypotension (systolic blood pressure < 90 mmHg). Results: From 1 April 2017 to 23 August 2017 we enrolled 20 patients (age: 64±9 years, males: 60%, n=12, anterior STEMI: 65%, n=13). The mean LVEDP for the whole cohort ( n=20) was 29±4 mmHg (intervention group: 28±3 mmHg vs. control group: 31±5 mmHg; p=0.1). The LVEDP dropped from 28±3 to 16±2 mmHg in the glyceryl trinitrate + furosemide group ( p <0.01) but remained unchanged in the control group. The median dose of glyceryl trinitrate required to produce ⩾ 20% reduction in LVEDP in the intervention group was 200 µg (range: 100–800). One patient experienced asymptomatic decline in systolic blood pressure to below 90 mmHg. There was no correlation between LVEDP and left ventricular ejection fraction. Conclusion: The administration of glyceryl trinitrate plus furosemide in patients with elevated LVEDP following primary percutaneous coronary intervention for STEMI safely reduces LVEDP.

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“…STEMI was defined as new ST elevation at the J point in at least 2 contiguous leads of 2 mm (0.2 mV) in men or 1.5 mm (0.15 mV) in women in leads V2–V3 and/or 1 mm (0.1 mV) in other contiguous chest leads or the limb leads 14 . Similar to our prior studies, all adult patients (≥18 years) with STEMI who underwent PPCI and had LVEDP measured were included 15,18 …”

Section: Methodsmentioning

confidence: 99%

“…14 Similar to our prior studies, all adult patients (≥18 years) with STEMI who underwent PPCI and had LVEDP measured were included. 15,18 LVEDP, SBP, and DBP were measured using 6F fluid-filled catheters (Witt Series IV Physiomonitoring System, Philips Medical Systems, Boeblingen, Germany). The Physiomonitoring system was balanced and calibrated before each patient was studied, in accordance with the manufacturer's instructions.…”

Section: Methodsmentioning

confidence: 99%

Ability of a novel shock index that incorporates invasive hemodynamics to predict mortality in patients with ST‐elevation myocardial infarction

McKenzie

Zhou

Svendsen

et al. 2021

Cathet Cardio Intervent

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Objective: To determine whether the use of invasively measured hemodynamics improves the prognostic ability of a shock index (SI).Background: SI such as Admission-SI, Age-SI, Modified SI (MSI), and Age-MSI predict short-term mortality in ST-elevation myocardial infarction (STEMI).Methods: Single-center study of 510 patients who underwent primary percutaneous coronary intervention. STEMI SI was defined as age × heart rate (HR) divided by coronary perfusion pressure (CPP). Results:The mean age was 62 ± 14 years, 66% were males with hypertension (69%), tobacco use (38%), diabetes (28%) and chronic kidney disease (6%). The mean HR, systolic blood pressure (SBP), and CPP were 81 ± 18 bpm, 124 ± 28 mmHg, and 52.8 ± 16.3 mmHg, respectively. Patients with STEMI SI ≥182 (n = 51) were more likely to experience a cardiac arrest in the catheterization laboratory (9.8% vs. 2.0%; p = .001), require mechanical circulatory support (47.1% vs. 8.5%; p < .0001) and be treated with vasopressors (56.9% vs. 10.7%; p < .0001) compared to STEMI SI < 182 (n = 459). After multivariate adjustment, patients with STEMI SI ≥182 were 10, 10.1 and 4.8 times more likely to die during hospitalization, at 30 days and at 5 years, respectively. The C statistic of STEMI SI was 0.870, similar to GRACE score (AUC = 0.902; p = .29) and TIMI STEMI score (AUC = 0.895; p = .36).Conclusion: STEMI SI is an easy to calculate risk score that identifies STEMI patients at high risk of in-hospital death.

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Correlation of infarct size with invasive hemodynamics in patients with ST‐elevation myocardial infarction

Cited by 11 publications

References 33 publications

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

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

Targeting elevated left ventricular end-diastolic pressure following primary percutaneous coronary intervention for ST-segment elevation myocardial infarction – a phase one safety and feasibility study

Ability of a novel shock index that incorporates invasive hemodynamics to predict mortality in patients with ST‐elevation myocardial infarction

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