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Published on: April 25, 2014
Correlation of infarct size with invasive hemodynamics in patients with ST-elevation myocardial infarction
Allie E Goins1, Robert Rayson1, Melissa C Caughey1
1Division of Cardiology, University of North Carolina, Chapel Hill, North Carolina.
Insights
Invasive hemodynamics during primary percutaneous coronary intervention (PPCI) can predict mortality in ST-elevation myocardial infarction (STEMI). The SBP/LVEDP ratio best correlates with infarct size and predicts mortality, aiding risk stratification.
Area of Science:
- Cardiology
- Invasive Hemodynamics
- Myocardial Infarction
Background:
- Invasive hemodynamic parameters measured during primary percutaneous coronary intervention (PPCI) are known predictors of mortality in ST-elevation myocardial infarction (STEMI).
- However, the specific hemodynamic parameters that best correlate with the size of the myocardial infarction remain unclear.
Purpose of the Study:
- To identify invasive hemodynamic parameters that demonstrate the strongest correlation with infarct size in patients with STEMI.
- To evaluate the association of these hemodynamic parameters with in-hospital mortality.
Main Methods:
- A single-center study involving 405 adult patients with STEMI undergoing PPCI.
- Left ventricular end-diastolic pressure (LVEDP) was measured during PPCI.
- Infarct size was estimated using peak troponin I levels and left ventricular ejection fraction (LVEF) determined by echocardiography.
Main Results:
- The SBP/LVEDP ratio showed the strongest correlation with peak troponin levels (r = -0.41), while LVEDP correlated best with LVEF (r = -0.40).
- Both SBP/LVEDP ratio (AUC = 0.76) and SBP (AUC = 0.77) demonstrated a stronger association with in-hospital mortality compared to LVEDP or pulse pressure (PP).
- Door-to-balloon time did not influence the correlations between hemodynamic parameters and infarct size.
Conclusions:
- The SBP/LVEDP ratio is a significant correlate of infarct size and a predictor of in-hospital mortality in STEMI patients undergoing PPCI.
- Measurement of LVEDP and SBP during PPCI can aid in the risk stratification of STEMI patients.
- These findings highlight the utility of invasive hemodynamic monitoring for assessing infarct severity and prognosis.
Objectives:
To identify invasive hemodynamic parameters that correlate with infarction size in patients with ST-elevation myocardial infarction (STEMI).
Background:
Invasive hemodynamics obtained during primary percutaneous coronary intervention (PPCI) are predictive of mortality in STEMI, but which parameters correlate best with the size of the infarction are unknown.
Methods:
This is a single-center study of 405 adult patients with STEMI who had left ventricular end-diastolic pressure (LVEDP) measured during PPCI. Size of infarction was estimated by peak troponin I level and ejection fraction (LVEF) determined by echocardiography.
Results:
The average (±SD) age was 61 ± 14 years, TIMI STEMI risk score was 3.5 ± 2.7 and Grace score was 157 ± 42. Hemodynamic parameters that correlated best with EF were LVEDP (r = -0.40), PP (r = 0.24), and SBP/LVEDP ratio (r = 0.22) and with peak troponin were SBP/LVEDP ratio (r = -0.41), LVEDP (r = 0.31), and PP (r = -0.29). SBP/LVEDP (AUC = 0.76) and SBP (AUC = 0.77) had a stronger association with in-hospital mortality than did LVEDP (AUC = 0.66) or PP (AUC = 0.64). Door-to-balloon time did not affect the correlations between hemodynamic parameters and infarct size.
Conclusions:
In this sample of 405 patients undergoing PPCI, SBP/LVEDP ratio had the strongest correlation with peak troponin levels and LVEDP with EF, whereas SBP/LVEDP and SBP had a strong association with in-hospital mortality. These results suggest that measurement of LVEDP as well as SBP may help risk stratify patients during PPCI.
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