Correlation of infarct size with invasive hemodynamics in patients with ST‐elevation myocardial infarction. Issue 5 (25th March 2018)

• Record Type: Journal Article
• Authors: Goins, Allie E.; Rayson, Robert; Caughey, Melissa C.; Sola, Michael; Venkatesh, Kiran; Dai, Xuming; Yeung, Michael; Stouffer, George A.
• Is Part Of: Catheterization and cardiovascular interventions. Volume 92:Issue 5(2018)
• Page Start: E333
• Page End: E340
• Publication Date: 2018-03-25
• Subjects: hemodynamics -- primary PCI -- STEMI; Heart -- Diseases -- Diagnosis -- Periodicals; Cardiac catheterization -- Periodicals; 616.1207572
• DOI: 10.1002/ccd.27625
• Languages: English
• ISSNs: 1522-1946

Abstract

Abstract: Objectives: To identify invasive hemodynamic parameters that correlate with infarction size in patients with ST‐elevation myocardial infarction (STEMI). Background: Invasive hemodynamics obtained during primary percutaneous coronary intervention (PPCI) are predictive of mortality in STEMI, but which parameters correlate best with the size of the infarction are unknown. Methods: This is a single‐center study of 405 adult patients with STEMI who had left ventricular end‐diastolic pressure (LVEDP) measured during PPCI. Size of infarction was estimated by peak troponin I level and ejection fraction (LVEF) determined by echocardiography. Results: The average (±SD) age was 61 ± 14 years, TIMI STEMI risk score was 3.5 ± 2.7 and Grace score was 157 ± 42. Hemodynamic parameters that correlated best with EF were LVEDP ( r = −0.40), PP ( r = 0.24), and SBP/LVEDP ratio ( r = 0.22) and with peak troponin were SBP/LVEDP ratio ( r = −0.41), LVEDP ( r = 0.31), and PP ( r = −0.29). SBP/LVEDP (AUC = 0.76) and SBP (AUC = 0.77) had a stronger association with in‐hospital mortality than did LVEDP (AUC = 0.66) or PP (AUC = 0.64). Door‐to‐balloon time did not affect the correlations between hemodynamic parameters and infarct size. Conclusions: In this sample of 405 patients undergoing PPCI, SBP/LVEDP ratio had the strongest correlation with peak troponin levels and LVEDP with EF, whereas SBP/LVEDP and SBP had a strong association with in‐hospital mortality. These results suggest that measurement of LVEDP as well as SBP may help risk stratify patients during PPCI.