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Published on: June 12, 2021
Impact of Left Ventricular End-Diastolic Pressure on Percutaneous Coronary Intervention Outcomes
Matthew Siano1, Yash Jobanputra1, Angelo Oliva1,2
1Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York.
Insights
Elevated left ventricular end-diastolic pressure (LVEDP) after percutaneous coronary intervention (PCI) significantly increases 1-year mortality risk. This risk is further amplified in patients with reduced left ventricular ejection fraction.
Area of Science:
- Cardiology
- Interventional Cardiology
- Heart Failure
Background:
- Left ventricular end-diastolic pressure (LVEDP) is a key hemodynamic parameter.
- Elevated LVEDP is linked to adverse outcomes post-percutaneous coronary intervention (PCI), particularly in acute coronary syndrome (ACS).
- The impact of LVEDP on outcomes in chronic coronary syndrome (CCS) or ACS patients undergoing PCI requires further elucidation.
Purpose of the Study:
- To assess the association between LVEDP levels and 1-year all-cause mortality in patients undergoing PCI.
- To investigate the influence of LVEDP on outcomes in patients with chronic coronary syndrome or ACS.
- To examine the combined effect of elevated LVEDP and reduced left ventricular ejection fraction (LVEF) on mortality.
Main Methods:
- A retrospective analysis of consecutive patients undergoing PCI between 2014 and 2021.
- Patients were stratified into three groups based on LVEDP: ≤14 mm Hg, 15-20 mm Hg, and >20 mm Hg.
- Primary outcome was 1-year all-cause mortality; supplemental analysis assessed LVEF impact in the highest LVEDP group.
Main Results:
- Patients with LVEDP >20 mm Hg exhibited higher comorbidity prevalence and coronary artery disease complexity.
- Compared to LVEDP ≤14 mm Hg, elevated LVEDP was associated with significantly increased 1-year all-cause mortality (aHR 1.47 for 15-20 mm Hg; aHR 3.00 for >20 mm Hg).
- In patients with LVEDP >20 mm Hg, LVEF <40% was linked to a higher 1-year mortality risk (aHR 2.71).
Conclusions:
- Elevated LVEDP is a significant predictor of increased 1-year mortality following PCI in patients with CCS or ACS.
- Higher LVEDP levels correlate with worse clinical outcomes.
- Systolic dysfunction, indicated by reduced LVEF, exacerbates mortality risk in patients with severely elevated LVEDP (>20 mm Hg).
Background:
Left ventricular end-diastolic pressure (LVEDP) is associated with adverse outcomes following percutaneous coronary intervention (PCI) for acute coronary syndrome (ACS). We evaluated the impact of LVEDP on outcomes in patients with chronic coronary syndrome or ACS undergoing PCI.
Methods:
Consecutive patients undergoing PCI between 2014 and 2021 were included. Patients with LVEDP ≤14 mm Hg were compared to those with LVEDP 15 to 20 mm Hg and LVEDP >20 mm Hg. The primary outcome was all-cause mortality at 1 year. A supplemental analysis was conducted in patients with LVEDP >20 mm Hg according to left ventricular ejection fraction.
Results:
There were significant differences in baseline characteristics between patients with LVEDP ≤14 mm Hg (n = 10,547), LVEDP 15 to 20 mm Hg (n = 5011), and LVEDP >20 mm Hg (n = 1621). Patients with LVEDP >20 mm Hg had the highest prevalence of comorbidities and complexity of coronary artery disease. Compared to patients with LVEDP ≤14 mm Hg, increased all-cause mortality was observed in patients with LVEDP 15 to 20 mm Hg (3.0% vs 1.6%; adjusted hazard ratio [aHR], 1.47; 95% CI, 1.15-1.87; P = .002) and LVEDP >20 mm Hg (7.6% vs 1.6%, aHR, 3.00; 95% CI, 2.31-3.90; P < .001) at 1 year. In patients with LVEDP >20 mm Hg, a left ventricular ejection fraction <40% was associated with increased 1-year all-cause mortality (11.4% vs 2.8%; aHR, 2.71; 95% CI, 1.36-5.37; P = .004).
Conclusions:
In a population of patients with chronic coronary syndrome and ACS undergoing PCI, elevated LVEDP was associated with increased mortality at 1 year. Systolic dysfunction was associated with higher mortality in patients with LVEDP >20 mm Hg.
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