左室拡張末期圧が経皮的冠動脈インターベンションの結果に及ぼす影響

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.

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.

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).

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.