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The use of hemodynamics to predict mortality in patients undergoing primary PCI for ST-elevation myocardial

Allie E Goins1, Robert Rayson1, Michael Yeung1

  • 1a Division of Cardiology and McAllister Heart Institute , University of North Carolina , Chapel Hill , NC , USA.

Expert Review of Cardiovascular Therapy
|July 6, 2018
PubMed

Insights

Hemodynamic parameters measured during primary percutaneous coronary intervention for ST-elevation myocardial infarction predict mortality. These measurements can identify high-risk patients who may not be in cardiogenic shock but are still at risk of pump failure.

Area of Science:

  • Cardiology
  • Critical Care Medicine
  • Cardiovascular Research

Background:

  • Predicting mortality and severe myocardial dysfunction in ST-elevation myocardial infarction (STEMI) patients undergoing primary percutaneous coronary intervention (PPCI) remains challenging.
  • While cardiogenic shock has a high mortality rate, patients dying from pump failure without cardiogenic shock are less understood.
  • Hemodynamic parameters have a long history in risk stratification for acute myocardial infarction (MI).

Purpose of the Study:

  • To evaluate the prognostic value of hemodynamic parameters in patients undergoing PPCI for STEMI.
  • To identify specific hemodynamic indicators associated with early mortality in this patient population.
  • To explore the utility of right heart catheterization parameters in assessing risk.

Main Methods:

  • Analysis of hemodynamic parameters obtained during PPCI for STEMI.
  • Assessment of parameters including systolic blood pressure (SBP), heart rate, left ventricular end diastolic pressure (LVEDP), and their ratios.
  • Evaluation of right heart catheterization data such as cardiac power, pulmonary capillary wedge pressure (PCWP), and cardiac output.

Main Results:

  • Low SBP, elevated heart rate, elevated LVEDP, and a low SBP/LVEDP ratio are associated with early mortality in PPCI patients.
  • Right heart catheterization parameters like cardiac power, PCWP, and cardiac output provide prognostic information in STEMI.
  • The Killip class, historically used, continues to offer prognostic value across different MI treatment eras.

Conclusions:

  • Hemodynamic parameters measured during PPCI offer crucial prognostic information for STEMI patients.
  • These parameters can help identify patients at high risk of mortality, including those not in overt cardiogenic shock.
  • Further research is needed to determine if these hemodynamic insights can guide the early use of mechanical circulatory support.
Abstract

Keywords:
STEMIhemodynamicsleft ventricular end diastolic pressureprimary angioplastysystolic blood pressure

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