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Association of left ventricular end-diastolic pressure with mortality in patients undergoing percutaneous coronary intervention for acute coronary syndromes


Leistner, David M; Dietrich, Steven; Erbay, Aslihan; Steiner, Julia; Abdelwahed, Youssef; Siegrist, Patrick T; Schindler, Matthias; Skurk, Carsten; Haghikia, Arash; Sinning, David; Riedel, Matthias; Landmesser, Ulf; Stähli, Barbara E (2020). Association of left ventricular end-diastolic pressure with mortality in patients undergoing percutaneous coronary intervention for acute coronary syndromes. Catheterization and Cardiovascular Interventions, 96(4):E439-E446.

Abstract

OBJECTIVES

This study sought to investigate the relation between left ventricular end-diastolic pressure (LVEDP) and outcomes in patients undergoing percutaneous coronary intervention (PCI) for acute coronary syndromes (ACS).

BACKGROUND

Risk stratification in ACS patients is important. Data on the role of LVEDP in the prognostication of ACS patients are scarce.

METHODS

A total of 1,410 patients undergoing PCI for ACS and with available data on LVEDP were divided according to LVEDP tertiles (lowest tertile: ≤13 mmHg, intermediate tertile: 14-20 mmHg, and highest tertile: >20 mmHg). The primary endpoint was all-cause mortality at a median follow-up of 246 [28-848] days.

RESULTS

Median LVEDP was 16 (11-22) mmHg. All-cause mortality was 2.8%, 4.5%, and 15.0% in the lowest, the intermediate, and the highest LVEDP tertile groups (p < .001), respectively. Belonging to the highest LVEDP tertile was associated with an increased risk of all-cause mortality (adjusted hazard ratio [HR] = 2.66, 95% confidence interval [CI] [1.30, 5.47], p = .008). By receiver operating characteristic curve analysis, the optimal cut-off value for predicting all-cause mortality was 20 mmHg (sensitivity 68.3%, specificity 72.5%). There was no differential effect of LVEDP on mortality in patients with and without LV dysfunction (interaction p = .23) or ST-elevation myocardial infarction as index ACS event (interaction p = .86).

CONCLUSIONS

In patients undergoing PCI for ACS, LVEDP was independently related with mortality. Hence, LVEDP should be incorporated into early risk stratification and clinical decision making of ACS patients.

Abstract

OBJECTIVES

This study sought to investigate the relation between left ventricular end-diastolic pressure (LVEDP) and outcomes in patients undergoing percutaneous coronary intervention (PCI) for acute coronary syndromes (ACS).

BACKGROUND

Risk stratification in ACS patients is important. Data on the role of LVEDP in the prognostication of ACS patients are scarce.

METHODS

A total of 1,410 patients undergoing PCI for ACS and with available data on LVEDP were divided according to LVEDP tertiles (lowest tertile: ≤13 mmHg, intermediate tertile: 14-20 mmHg, and highest tertile: >20 mmHg). The primary endpoint was all-cause mortality at a median follow-up of 246 [28-848] days.

RESULTS

Median LVEDP was 16 (11-22) mmHg. All-cause mortality was 2.8%, 4.5%, and 15.0% in the lowest, the intermediate, and the highest LVEDP tertile groups (p < .001), respectively. Belonging to the highest LVEDP tertile was associated with an increased risk of all-cause mortality (adjusted hazard ratio [HR] = 2.66, 95% confidence interval [CI] [1.30, 5.47], p = .008). By receiver operating characteristic curve analysis, the optimal cut-off value for predicting all-cause mortality was 20 mmHg (sensitivity 68.3%, specificity 72.5%). There was no differential effect of LVEDP on mortality in patients with and without LV dysfunction (interaction p = .23) or ST-elevation myocardial infarction as index ACS event (interaction p = .86).

CONCLUSIONS

In patients undergoing PCI for ACS, LVEDP was independently related with mortality. Hence, LVEDP should be incorporated into early risk stratification and clinical decision making of ACS patients.

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Additional indexing

Item Type:Journal Article, refereed, original work
Communities & Collections:04 Faculty of Medicine > University Hospital Zurich > Clinic for Cardiology
Dewey Decimal Classification:610 Medicine & health
Scopus Subject Areas:Health Sciences > Radiology, Nuclear Medicine and Imaging
Health Sciences > Cardiology and Cardiovascular Medicine
Language:English
Date:1 October 2020
Deposited On:01 Feb 2021 17:03
Last Modified:02 Feb 2021 21:01
Publisher:Wiley-Blackwell Publishing, Inc.
ISSN:1522-1946
OA Status:Closed
Publisher DOI:https://doi.org/10.1002/ccd.28839
PubMed ID:32141669

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