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[Prognostic value of pulmonary hemodynamic parameters for predicting survival in acute coronary syndrome]
R L Quan1, D A Huang2, L P Pang2
1Department of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medial Sciences and Peking Union Medical College, Beijing 100037, China.
Insights
Pulmonary hemodynamics, including mean pulmonary arterial pressure (mPAP) and diastolic pressure gradient (DPG), significantly predict survival in acute coronary syndrome (ACS) patients. Incorporating these measures improves risk assessment beyond the GRACE score.
Area of Science:
- Cardiology
- Pulmonary Hypertension
- Acute Coronary Syndrome
Background:
- Acute coronary syndrome (ACS) poses significant mortality risks.
- Risk stratification in ACS is crucial for patient management.
- Pulmonary hypertension (PH) is increasingly recognized in left heart disease.
Purpose of the Study:
- To investigate the prognostic implications of pulmonary hemodynamics in ACS patients.
- To assess whether hemodynamic parameters enhance existing risk scores for ACS mortality.
Main Methods:
- Prospective multicenter registry study involving ACS patients undergoing cardiac catheterization.
- Lasso analysis identified prognostic variables for the GRACE score.
- Right heart catheterization measured pulmonary arterial pressures (mPAP, sPAP) and DPG.
- Model performance evaluated with and without hemodynamic parameters.
Main Results:
- Pulmonary hemodynamics (mPAP, sPAP, DPG) were significant predictors of all-cause mortality in ACS.
- The Global Registry of Acute Coronary Events (GRACE) score showed moderate predictive ability (C-index 0.703).
- Adding mPAP or DPG to the GRACE score improved mortality prediction (C-index increased, IDI improved).
Conclusions:
- Pulmonary hemodynamic parameters offer valuable prognostic information in ACS.
- These parameters provide incremental value to current risk assessment tools like the GRACE score.
- Further research into PH in ACS may refine patient stratification and treatment strategies.
Abstract:
Objective: To explore the characteristics and prognostic value of pulmonary hemodynamics in patients with acute coronary syndrome (ACS). Methods: From a prospective multicenter registry study of pulmonary hypertension due to left heart disease, consecutive ACS patients who underwent coronary angiography in combination with left and right heart catheterization during hospitalization between January 2013 and November 2016 were involved. The primary endpoint was all-cause mortality. The prognostic variables identified by the Lasso analysis were included in the Global Registry of Acute Coronary Events (GRACE) score. Model performance was evaluated before and after the addition of hemodynamic parameters. Results: A total of 251 patients were enrolled, with age of (63.7±11.5) years. A total of 198 males (78.9%) and 53 females (21.1%) were recruited, and the median follow-up time was 34.7 months. Right heart catheterization-assessed mean pulmonary arterial pressure (mPAP), systolic pulmonary arterial pressure (sPAP) and diastolic pressure gradient (DPG) were found to be significant predictors for survival in ACS. Adjusted for age and sex, the adjusted HR (95%CI) of mPAP, sPAP and DPG were 1.068 (1.015-1.123), 1.033 (1.002-1.065) and 1.094 (1.008-1.187), respectively (P<0.05). Applied to the present cohort of 251 patients, the median of the GRACE score was 123 points, with a C-index of 0.703 (95%CI: 0.615-0.791) for predicting mortality. After the addition of mPAP or DPG to the GRACE score, the C-index increased to 0.715 (95%CI: 0.629-0.801) or 0.711 (95%CI: 0.625-0.797), respectively. When comparing two models before and after the addition of mPAP or DPG, the integrated discriminatory index (IDI) was 4.3% (95%CI: 0.2%-13.5%, P=0.030) and 3.0% (95%CI: 0.2%-11.1%, P=0.020), respectively. Conclusion: Pulmonary hemodynamics can be predictive for survival in ACS patients, providing incremental prognostic value to risk assessment in ACS.
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