Hemodynamic changes acutely determined by primary PCI in STEMI patients evaluated with a minimally invasive method

Abstract

Objective: Few studies are available on the hemodynamic changes acutely determined by Primary Percutaneous Coronary Intervention (PCI) in ST-Elevation Myocardial Infarction (STEMI) patients, probably for the difficult evaluation of hemodynamic variables in this acute setting. Therefore, the paper is to evaluate the variations of several hemodynamic parameters determined by PCI using PRAM (Pressure Recording Analytical Method), minimally invasive hemodynamic monitoring. Methods: We analyzed in 20 STEMI patients submitted to PCI several hemodynamic variables, assessed with PRAM from radial/ femoral artery, 3-minute before PCI and at endprocedure. Variables measures were: systolic, diastolic, dicrotic and mean arterial pressures; heart rate (HR); stroke volume (SV); systemic vascular resistance (SVR); dP/dt max ; cardiac cycle efficiency (CCE). Results: In our patients HR, SVR and dP/dt max decreased significantly (85 ± 6.3 to 77 ± 4.5, p = 0.002; 1738 ± 241 to 1450 ± 253, p = 0.022; 1.22 ± 0.11 to 1.11 ± 0.12, p = 0.007, respectively) while CCE and SV increased significantly (−0.25 ± 0.23 to −0.01 ± 0.12, p < 0.001; 53 ± 8.4 to 65 ± 11.2, p < 0.001, respectively). Conclusions: Hemodynamic monitoring with PRAM seems feasible during primary PCI and can provide further notions regarding the acute effects determined on cardiovascular system by the culprit artery revascularization. The most significant hemodynamic changes acutely observed in our study should be mainly ascribed to the reduction in sympathetic activity after PCI with a rapid improvement of the cardiovascular system efficiency.

The Use of Pressure Recording Analytical Method in Patients Undergoing Endovascular Repair for Abdominal Aortic Aneurysm: The Impact on Clinical Decisions for the Appropriate Postoperative Setting and Cost-effective Analysis

“…This device has been previously explored at our Institution in several acute cardiac conditions, such as heart failure (19,20) and ST-segment Elevation Myocardial Infarction (21), as well as in the postoperative phase of cardiac surgery. In the latter study, reduced perioperative values of Cardiac Cycle Efficiency demonstrated a negative prognostic impact at six months follow-up (4).…”

“…In the last 20 years, the PRAM system has been used in different clinical conditions, both in our Center and in other Centers. In particular, in our Center it has been used to monitor patients with decompensated heart failure treated with ultrafiltration and diuretics (19,20), as well as to evaluate the beneficial effects of levosimendan (34), in patients with atrial fibrillation undergoing electrical cardioversion (35), in patients with ST-Elevation myocardial infarction treated with primary angioplasty (21), to monitor patients undergoing transcatheter aortic valve replacement (36,37), and in patients undergoing cardiac and vascular surgery, both intraoperatively (32) and in the postoperative course of cardiac surgery (4). In other Centers, the PRAM system has been used to monitor patients with septic shock (38), in patients undergoing major abdominal surgery (39) or cardiac surgery (1,40).…”

“…Among them, the Pressure Recording Analytical Method (PRAM) system has been widely used in our Institution to evaluate hemodynamic parameters in several cardiac conditions, such as heart failure and acute myocardial infarction (19)(20)(21). PRAM is a minimally invasive monitoring system that provides, from the beat-to-beat analysis of the arterial waveform, measurement of the main hemodynamic variables, such as systemic blood pressures, stroke volume, cardiac output, and vascular resistances.…”