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Prognostic Utility of Pulmonary Arterial Elastance in Patients With ST-Segment Elevation Myocardial Infarction

Shotaro Kawai1, Kensaku Nishihira1, Toshiyuki Kimura1

  • 1Department of Cardiology, Miyazaki Medical Association Hospital Miyazaki Japan.

Circulation Reports
|June 11, 2026
PubMed

Insights

Pulmonary arterial elastance (PaE) can predict in-hospital death in ST-segment elevation myocardial infarction (STEMI) patients with Killip classes 3-4. This measure offers a valuable tool for early risk stratification in critical cardiac care.

Area of Science:

  • Cardiology
  • Hemodynamics
  • Critical Care Medicine

Background:

  • Invasive hemodynamic assessment is crucial for ST-elevation myocardial infarction (STEMI) patients in Killip classes 3-4.
  • The prognostic value of pulmonary arterial elastance (PaE) in this high-risk group is not well-established.

Purpose of the Study:

  • To investigate the prognostic utility of pulmonary arterial elastance (PaE) in predicting in-hospital mortality among STEMI patients with Killip classes 3-4.

Main Methods:

  • A retrospective analysis of 145 STEMI patients (Killip classes 3-4) who underwent primary percutaneous coronary intervention.
  • PaE was calculated as systolic pulmonary artery pressure divided by stroke volume.
  • Comparison of PaE with other hemodynamic parameters like pulmonary vascular resistance and cardiac power output for discriminative ability.

Main Results:

  • In-hospital mortality was 18.6% (27 patients).
  • Non-survivors had significantly higher PaE compared to survivors (1.40 vs. 0.81 mmHg/mL, P<0.001).
  • PaE independently predicted in-hospital death and demonstrated superior discriminative ability compared to pulmonary vascular resistance and PAPI.

Conclusions:

  • Pulmonary arterial elastance (PaE) is an independent predictor of in-hospital death in STEMI patients with Killip classes 3-4.
  • The ease of calculation and robust performance across subgroups support PaE's utility in early risk stratification.
  • Higher PaE values correlate with increased in-hospital mortality rates.
Abstract

Keywords:
HemodynamicsKillip classPulmonary arterial elastancePulmonary artery catheterST-segment elevation myocardial infarction

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