Elevated myocardial wall stress after percutaneous coronary intervention in acute ST elevation myocardial infraction
Sharma Kattel1,2, Hardik Bhatt1, Sharda Gurung1
1Department of Medicine, Division of Cardiology, Jacob's School of Medicine and Biomedical Sciences, Buffalo, New York, USA.
Insights
Elevated end-systolic myocardial wall stress (MWS) after ST-elevation myocardial infarction (STEMI) treatment predicts long-term mortality. Echocardiogram-derived MWS aids in risk-stratifying STEMI patients post-percutaneous coronary intervention (PCI).
Area of Science:
- Cardiology
- Cardiovascular Imaging
- Interventional Cardiology
Background:
- Percutaneous coronary intervention (PCI) aims to preserve myocardium in ST-elevation myocardial infarction (STEMI) but subsequent changes in myocardial wall stress (MWS) can lead to ventricular dysfunction.
- The long-term impact of MWS changes on major adverse cardiovascular events (MACE) after STEMI and PCI remains unclear.
Purpose of the Study:
- To investigate the association between MWS and long-term MACE, including all-cause mortality, in patients successfully treated with PCI for acute STEMI.
Main Methods:
- A prospective study enrolled 142 STEMI patients undergoing emergent PCI.
- End-systolic and end-diastolic MWS were calculated using echocardiographic indices.
- Patients were followed for an average of 16.5 months to assess mortality and MACE.
Main Results:
- During follow-up, 9% of patients died and 17% experienced MACE.
- Patients who died had significantly higher end-systolic MWS (ESWS) compared to survivors.
- Elevated ESWS (>62.5 Kpa) and older age were significant predictors of mortality in multivariate analysis.
Conclusions:
- Elevated ESWS, measured via echocardiogram, is linked to increased long-term mortality risk in STEMI patients post-PCI.
- This finding offers a valuable tool for clinicians to identify and manage high-risk STEMI patients.
Background:
Despite early attempts to salvage myocardium-at-risk with percutaneous coronary intervention (PCI), changes in myocardial wall stress (MWS) leads to ventricular dilatation and dysfunction after acute ST-elevation myocardial infraction (STEMI). Whether this is transient or leads to long-term adverse outcomes major adverse cardiovascular events (MACE) is not known. We studied the association between MWS and MACE in patients after a successful PCI for acute STEMI.
Objectives:
To study the MWS in percutaneously revascularized STEMI patients in relation to all-cause mortality and MACE.
Methods:
We prospectively enrolled 142 patients who presented to our tertiary care hospital with acute STEMI requiring emergent PCI. In addition to the standard clinical biomarkers, both end-systolic and end-diastolic MWS was calculated using our recently validated Echocardiographic indices. Patients were then prospectively followed up to an average of 16.5 (± 12.0) months to assess all-cause mortality and MACE.
Results:
During the follow-up period, 9% of the patients died and 17% developed MACE. Patients who died had significantly elevated end-systolic WS compared to those who survived (mean ESWS, 80.01 ± 36.86 vs 59.28 ± 27.68). There was no significant difference in end-diastolic WS, left ventricular systolic function and peak troponin levels among survivors versus non-survivors. Elevated ESWS (>62.5 Kpa) and age remained the significant predictors of mortality on multivariate logistic analysis (OR 7.75, CI 1.33-73.86, P = .03; OR 1.16, CI 1.06-1.31, P = .002).
Conclusion:
Elevated ESWS measured by echocardiogram is associated with increased odds of long-term mortality in STEMI patients who have undergone emergent PCI. This finding can help clinicians to risk stratify high-risk patients.
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