In PCI for ACS, elevated LV end-diastolic pressure may confer mortality risk
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Among patients undergoing PCI for ACS, elevated left ventricular end-diastolic pressure was associated with a significant increase in risk for all-cause mortality.
According to a study published in Catheterization and Cardiovascular Interventions, among 1,410 patients who underwent PCI for ACS, the crude mortality rates at a median follow-up of 246 days were 2.8% in those with LV end-diastolic pressure (LVEDP) 13 mm Hg or less, 4.5% in those with LVEDP 14 mm Hg to 20 mm Hg and 15% in those with LVEDP greater than 20 mm Hg.
Patients with LVEDP greater than 20 mm Hg experienced elevated risk for all-cause mortality (adjusted HR = 2.66; 95% CI, 1.3-5.47) compared with those with LVEDP 13 mm Hg or less, according to the researchers.
In addition, patients with LVEDP greater than 20 mm Hg had greater risk for rehospitalization for HF (aHR = 1.82; 95% CI, 1.28-2.59) compared with those with LVEDP 13 mm Hg or less.
“In patients undergoing PCI for ACS, LVEDP was independently related with mortality,” David M. Leistner, MD, of the department of cardiology of the Charité Berlin-University Medicine, Berlin, and colleagues wrote. “Hence, LVEDP should be incorporated into early risk stratification and clinical decision-making of ACS patients.”
After receiver operating characteristic curve analysis, researchers determined that the optimal cutoff for predicting all-cause mortality was LVEDP of 20 mm Hg (sensitivity 68.3%, specificity 72.5%).
According to the study, there were no differential effects of LVEDP on mortality based on LV dysfunction (P for interaction = .23) or type of index ACS event (P for interaction = .86).
“The observed relation of LVEDP with worse outcomes in ACS patients supports the concept of cardioprotection by mechanical unloading of the left ventricle,” the researchers wrote. “Whether targeted therapy aiming at defined left ventricular filling pressures will improve outcomes in ACS patients, however, remains to be investigated in future randomized studies.” – by Scott Buzby
Disclosures: The authors report no relevant financial disclosures.
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