In this study, we evaluated the change in left ventricular end-diastolic pressure (LVEDP) after primary percutaneous coronary intervention (PCI) and its impact on in-hospital outcomes and 30-day and three-month quality of life (SAQ-7), ejection fraction (EF), and major adverse cardiovascular events (MACE). LVEDP ≥19 mmHg was taken as elevated LVEDP. In a sample of 318 patients, 18.9% (n=60) were females and mean age was 55.7 ± 10.52 years. Post-procedure elevated LVEDP was observed in 20.8% (n=66) with a mean reduction of 1.65 ± 4.35 mmHg. LVEDP declined in 39% (n=124) and increased in 10.7% (n=34). In-hospital mortality rate (9.1% vs. 2.4%, p=0.011), 30-day MACE (9.1% vs. 4.0%), and three-month MACE (21.2% vs. 5.6%) were found to be significantly higher among patients with elevated LVEDP, respectively. Elevated LVEDP was found to be associated with a reduced SAQ-7 score (89.84 ± 8.09 vs. 92.29 ± 3.03, p<0.001) and reduced (25–40%) EF (55.6% vs. 22.6%) at three-month follow-up. LVEDP declined acutely in a significant number of patients after primary PCI. Post-procedure elevated LVEDP was found to be associated with poor quality of life and an increased risk of immediate and short-term MACE.
Introduction
ST-elevation myocardial infarction (STEMI) is an acute ischaemic event associated with an increased risk of clinical complications, poor recovery, and adverse cardiovascular events.1 Owing to the recent development and advancements in management, outcomes of STEMI patients have improved significantly.2 Primary percutaneous coronary intervention (PCI) remains the recommended treatment option by both European and American clinical practice guidelines.3,4
In addition to improvements in the management strategy, risk stratification of patients with STEMI improved extensively with the introduction of various risk-stratification modalities.5 Over the years, various biomarkers and clinical characteristics have been evaluated for their prognostic role, including gender, age, patient-related comorbid conditions, arrhythmias, location and size of the infarct, haemodynamic complications (cardiogenic shock), and ischaemic mitral regurgitation.1 The prognostic role of left ventricular systolic dysfunction (i.e. left ventricular ejection fraction – LVEF) is well established for patients with STEMI.6 However, the acute event of STEMI causes multiple functional and structural changes at the microcirculation level, which leads to elevated left ventricular end-diastolic pressure (LVEDP). Therefore, left ventricular diastolic dysfunction (i.e. LVEDP) recently gained attention as a prognostic marker for patients with STEMI.7–10
LVEDP is an integrative measure of total left ventricular function, and LVEDP change can be utilised as a significant prognostic indicator to guide medical therapy, and assess risk for post-STEMI adverse events. LVEDP is often measured during primary PCI, and a few studies have been conducted assessing the relationship between LVEDP and myocardial salvage.11 Not many of these studies have been conducted in South Asia, particularly in Pakistan. Therefore, we aimed to assess the improvement in post-procedure LVEDP after PCI and its impact on short-term (three-month) outcomes in terms of quality of life (Seattle Angina Questionnaire [SAQ]-7), ejection fraction (EF), and major adverse cardiovascular events (MACE).
Materials and method
Study setting
This descriptive observational cohort study was conducted at a tertiary care cardiac centre in Karachi, Pakistan. The study was approved by the ethical review board of the hospital (ERC/121/2021) and consent for participation in the study and follow-up was taken from all the patients. Study duration was between January 2022 and June 2022.
Study population
In this study, we included consecutive patients of a first acute event of STEMI, either gender, age ≥18 years, and undergoing primary PCI. Patients with a prior history of coronary artery disease (CAD) or heart failure (HF), patients in cardiogenic shock at the time of presentation to the emergency department, and patients with any structural abnormality that can potentially lead to an increase in LVEDP were excluded from this study.
According to the study conducted by Cap et al.,12 the mean pre-primary PCI LVEDP was 22.1 ± 4.8 mmHg, and the post-primary PCI LVEDP was 19.4 ± 4.8 mmHg; using these statistics to test the hypothesis of significant post-procedure improvement in LVEDP at 5% level significance and 80% power of the test, the minimum required sample size for the study was calculated to be 27 patients. However, considering the expected three-month MACE rate of 15%, at a 95% confidence level (95%CI) and 4% margin of error, the sample size was calculated to be 307 patients. Hence, a total of 318 patients were recruited for this study.
Management and assessment of outcomes
As per the institutional protocol, all the primary PCI procedures were performed free of cost by the on-call team of interventional cardiologists. The pre- and post-LVEDP (mmHg) was measured for all patients as a measurement of pressure within the left ventricle following the completion of diastolic filling, just prior to systole. The primary end point of the study was the assessment of an improvement in post-procedure LVEDP. The secondary end point was the assessment of quality of life, improvement in EF (%), and MACE three months after the procedure. All the patients were followed, by telephone or physically, during their hospital stay, 30 days after discharge, and three months after discharge, and MACE, along with EF on transthoracic echocardiography (TTE) and quality of life using the SAQ-7 were assessed.
Measurements and definitions
STEMI was diagnosed based on positive electrocardiogram (ECG) findings at the time of presentation in the emergency department and a history of typical chest pain for at least 20 minutes. The positive ECG changes included ST-elevation in at least two contiguous leads >2 mm in men or >1 mm in women in leads V2 to V3, and/or >1 mm in other contiguous chest leads or limb leads. In-hospital outcomes included emergency coronary artery bypass grafting (CABG), major bleeding (requiring blood transfusion), stent thrombosis, cerebrovascular accident (CVA)/stroke, and death. The 30-day and three-month cumulative MACE included in-hospital all-cause death, post-discharge all-cause death, re-infarction/myocardial infarction, repeat revascularisation, and hospitalisation due to heart failure.
Data analysis procedure
The total SAQ-7 score was computed as an average of seven elements re-scaled to 0 to 100 from a scale of 1–6 for five elements and 1–5 for two elements. The SAQ score was categorised as fair (<50), good (50–75), and excellent (75–100). The EF was categorised as 25–40%, 41–50%, and more than 50%. Although multiple cut-off values for LVEDP have been used in the literature, a cut-off value of LVEDP >18 mmHg (i.e. ≥19 mmHg) has proven to be a significant predictor of MACE following primary PCI;10 therefore, we categorised patients into two groups with LVEDP ≥19 mmHg as criterion for elevated LVEDP. Clinical characteristics and outcomes were compared between the two groups with the help of appropriate independent sample t-test/Mann-Whitney U-test or Chi-square test/Fisher’s exact test at a 5% level of significance using IBM SPSS version 21.
Results
A total of 318 patients were included in this study; the proportion of female patients was 18.9% (n=60), and the mean age of the study sample was 55.7 ± 10.52 years. Elevated post-primary PCI LVEDP was observed in 20.8% (n=66) of the patients. LVEDP declined (by at least 1 mmHg) in 39% (n=124), increased (by at least 1 mmHg) in 10.7% (n=34), and remained the same in the remaining 50.3% (n=160) of the patients. Post-procedure elevated LVEDP was found to be associated with male gender (90.9% vs. 78.6%, p=0.023) and Killip class II (30.3% vs. 8.7%) or III (12.1% vs. 6.3%, p<0.001) (table 1).
Table 1. The comparison of clinical and demographic characteristics for patients with and without elevated left ventricular end-diastolic pressure (LVEDP) after primary percutaneous coronary intervention (PCI)
| Total | Post-procedure LVEDP | p value | ||
|---|---|---|---|---|
| <19 mmHg | ≥19 mmHg | |||
| Total, N (%) | 318 | 252 (79.2%) | 66 (20.8%) | |
| Male, n (%) | 258 (81.1%) | 198 (78.6%) | 60 (90.9%) | 0.023 |
| Female, n (%) | 60 (18.9%) | 54 (21.4%) | 6 (9.1%) | |
| Height, mean ± SD cm | 166.4 ± 8.42 | 165.49 ± 8.79 | 169.88 ± 5.61 | <0.001 |
| Weight, mean ± SD kg | 69.8 ± 10.26 | 69.4 ± 10.19 | 71.3 ± 10.45 | 0.181 |
| Age, mean ± SD years | 55.7 ± 10.52 | 56.43 ± 10.77 | 52.94 ± 9.03 | 0.016 |
| Systolic blood pressure, median (IQR) mmHg |
130 (110–145) | 130 (110–150) | 120 (110–140) | 0.018 |
| Diastolic blood pressure, median (IQR) mmHg |
80 (70–90) | 80 (70–90) | 80 (70–82) | 0.245 |
| Heart rate, median (IQR) bpm | 86 (76–96) | 84 (75–92) | 88 (78–100) | 0.069 |
| Chest pain to ER time, median (IQR) minutes |
240 (120–360) | 233 (120–360) | 240 (180–480) | 0.094 |
| ER to cath lab time, median (IQR) minutes |
100 (65–130) | 100 (65–130) | 100 (60–130) | 0.724 |
| Killip class, n (%) | ||||
| I | 252 (79.2%) | 214 (84.9%) | 38 (57.6%) | <0.001 |
| II | 42 (13.2%) | 22 (8.7%) | 20 (30.3%) | |
| III | 24 (7.5%) | 16 (6.3%) | 8 (12.1%) | |
| Comorbid conditions, n (%) | ||||
| Hypertension | 174 (54.7%) | 132 (52.4%) | 42 (63.6%) | 0.102 |
| Diabetes mellitus | 120 (37.7%) | 92 (36.5%) | 28 (42.4%) | 0.377 |
| Smoking | 94 (29.6%) | 74 (29.4%) | 20 (30.3%) | 0.882 |
| Family history of IHD | 36 (11.3%) | 28 (11.1%) | 8 (12.1%) | 0.818 |
| Chronic kidney disease | 6 (1.9%) | 6 (2.4%) | 0 (0%) | 0.206 |
| Type of myocardial infarction, n (%) | ||||
| Anterior | 166 (52.2%) | 122 (48.4%) | 44 (66.7%) | 0.068 |
| Inferior | 108 (34%) | 90 (35.7%) | 18 (27.3%) | |
| Inferior, posterior | 18 (5.7%) | 16 (6.3%) | 2 (3%) | |
| Lateral | 16 (5%) | 16 (6.3%) | 0 (0%) | |
| Posterior | 8 (2.5%) | 6 (2.4%) | 2 (3%) | |
| Posterior, lateral | 2 (0.6%) | 2 (0.8%) | 0 (0%) | |
| Key: CAD = coronary artery disease; ER = emergency room; IHD = ischaemic heart disease; IQR = interquartile range; LVEDP = left ventricular end-diastolic pressure; SD = standard deviation | ||||
A mean reduction of 1.65 ± 4.35 mmHg in LVEDP was observed after the procedure compared with the pre-procedure LVEDP. Post-procedure elevated LVEDP was found to be associated with pre-procedure TIMI (Thrombolysis in Myocardial Infarction) flow grade 0 (72.7% vs. 46.0%), myocardial blush grade (MBG) 0 (78.8% vs. 46.0%), culprit left anterior descending artery (66.7% vs. 49.2%), elevated pre-procedure LVEDP (22.45 ± 3.67 vs. 15.88 ± 5.71 mmHg), and reduced LVEF (33.64 ± 10.83% vs. 41.98 ± 7.76%) (table 2).
Table 2. The comparison of angiographic findings for patients with and without elevated LVEDP after primary PCI
| Total | Post-procedure LVEDP | p value | ||
|---|---|---|---|---|
| <19 mmHg | ≥19 mmHg | |||
| Total, N (%) | 318 | 252 (79.2%) | 66 (20.8%) | |
| Pre-procedure LVEF, mean ± SD % | 40.25 ± 9.12 | 41.98 ± 7.76 | 33.64 ± 10.83 | <0.001 |
| Pre-procedure LVEDP, mean ± SD mmHg | 17.25 ± 5.97 | 15.88 ± 5.71 | 22.45 ± 3.67 | <0.001 |
| Fluoroscopy times, mean ± SD minutes | 13.85 ± 6.8 | 13.07 ± 6.04 | 16.8 ± 8.59 | <0.001 |
| Contrast volume, median (IQR) ml | 100 (90–120) | 100 (90–120) | 100 (100–120) | 0.208 |
| Export catheter used, n (%) | 16 (5%) | 10 (4%) | 6 (9.1%) | 0.090 |
| Pre-procedure TIMI flow grade, n (%) | ||||
| 0 | 164 (51.6%) | 116 (46%) | 48 (72.7%) | 0.001 |
| I | 26 (8.2%) | 22 (8.7%) | 4 (6.1%) | |
| II | 72 (22.6%) | 62 (24.6%) | 10 (15.2%) | |
| III | 56 (17.6%) | 52 (20.6%) | 4 (6.1%) | |
| Pre-procedure MBG grade, n (%) | ||||
| 0 | 168 (52.8%) | 116 (46%) | 52 (78.8%) | <0.001 |
| I | 28 (8.8%) | 22 (8.7%) | 6 (9.1%) | |
| II | 82 (25.8%) | 76 (30.2%) | 6 (9.1%) | |
| III | 40 (12.6%) | 38 (15.1%) | 2 (3%) | |
| Number of involved vessels, n (%) | ||||
| Single-vessel disease | 110 (34.6%) | 92 (36.5%) | 18 (27.3%) | 0.369 |
| Two-vessel disease | 106 (33.3%) | 82 (32.5%) | 24 (36.4%) | |
| Three-vessel disease | 102 (32.1%) | 78 (31%) | 24 (36.4%) | |
| Culprit vessel, n (%) | ||||
| Left anterior descending artery | 168 (52.8%) | 124 (49.2%) | 44 (66.7%) | 0.030 |
| Right coronary artery | 98 (30.8%) | 86 (34.1%) | 12 (18.2%) | |
| Left circumflex artery | 46 (14.5%) | 36 (14.3%) | 10 (15.2%) | |
| Diagonal | 6 (1.9%) | 6 (2.4%) | 0 (0%) | |
| Post-procedure TIMI flow grade, n (%) | ||||
| 0 | 4 (1.3%) | 4 (1.6%) | 0 (0%) | 0.038 |
| I | 4 (1.3%) | 4 (1.6%) | 0 (0%) | |
| II | 12 (3.8%) | 6 (2.4%) | 6 (9.1%) | |
| III | 298 (93.7%) | 238 (94.4%) | 60 (90.9%) | |
| Post-procedure MBG grade, n (%) | ||||
| 0 | 0 (0%) | 0 (0%) | 0 (0%) | 0.259 |
| I | 4 (1.3%) | 4 (1.6%) | 0 (0%) | |
| II | 26 (8.2%) | 18 (7.1%) | 8 (12.1%) | |
| III | 288 (90.6%) | 230 (91.3%) | 58 (87.9%) | |
| Post-procedure LVEDP, mean ± SD mmHg | 15.59 ± 5.15 | 13.56 ± 3.16 | 23.33 ± 3.73 | <0.001 |
| Change in LVEDP, mean ± SD mmHg | –1.65 ± 4.35 | –2.32 ± 4.58 | 0.88 ± 1.71 | <0.001 |
| Key: IQR = interquartile range; LVEDP = left ventricular end-diastolic pressure; LVEF = left ventricular ejection fraction; MBG = myocardial blush grade; SD = standard deviation; TIMI = thrombolysis in myocardial infarction | ||||
In-hospital mortality rate (9.1% vs. 2.4%, p=0.011), 30-day MACE (9.1% vs. 4.0%), and three-month MACE (21.2% vs. 5.6%) were found to be significantly higher among patients with elevated LVEDP compared with patients with normal LVEDP level, respectively. Elevated LVEDP was also found to be associated with a reduced LVEF and SAQ-7 score at 30-day and three-month follow-ups (tables 3 and 4).
Table 3. The comparison of post-procedure in-hospital, 30-day, and 3-month outcomes for patients with and without elevated LVEDP after primary PCI
| Total | Post-procedure LVEDP | p value | ||
|---|---|---|---|---|
| <19 mmHg | ≥19 mmHg | |||
| Total, N (%) | 318 | 252 (79.2%) | 66 (20.8%) | |
| In-hospital outcomes, n (%) | ||||
| Successful procedure | 312 (98.1%) | 250 (99.2%) | 62 (93.9%) | 0.005 |
| Discharged home | 304 (95.6%) | 244 (96.8%) | 60 (90.9%) | 0.037 |
| Emergency CABG | 2 (0.6%) | 2 (0.8%) | 0 (0%) | 0.468 |
| Stent thrombosis | 0 (0%) | 0 (0%) | 0 (0%) | – |
| Major bleeding | 0 (0%) | 0 (0%) | 0 (0%) | – |
| Stroke/CVA | 0 (0%) | 0 (0%) | 0 (0%) | – |
| Death | 12 (3.8%) | 6 (2.4%) | 6 (9.1%) | 6 (9.1%) |
| 30-day outcome | ||||
| Available, N (%) | 236 (74.2%) | 188 (74.6%) | 48 (72.7%) | 0.756 |
| LVEF %, n (%) | ||||
| Echo not done | 40 (16.9%) | 40 (21.3%) | 0 (0%) | <0.001 |
| 25–40% | 108 (45.8%) | 72 (38.3%) | 36 (75%) | |
| 41–50% | 48 (20.3%) | 36 (19.1%) | 12 (25%) | |
| >50% | 40 (16.9%) | 40 (21.3%) | 0 (0%) | |
| SAQ-7 score, mean ± SD | 91.16 ± 7.3 | 91.19 ± 7.55 | 91.07 ± 6.31 | 0.923 |
| Fair: SAQ-7 score (≤50), n (%) | 0 (0%) | 0 (0%) | 0 (0%) | 0.562 |
| Good: SAQ-7 score (51–75), n (%) | 14 (5.9%) | 12 (6.4%) | 2 (4.2%) | |
| Excellent: SAQ-7 score (76–100), n (%) | 222 (94.1%) | 176 (93.6%) | 46 (95.8%) | |
| 3-month outcome | ||||
| Available, N (%) | 204 (64.2%) | 168 (66.7%) | 36 (54.5%) | 0.068 |
| LVEF %, n (%) | ||||
| Echo not done | 88 (43.1%) | 80 (47.6%) | 8 (22.2%) | <0.001 |
| 25–40% | 58 (28.4%) | 38 (22.6%) | 20 (55.6%) | |
| 41–50% | 18 (8.8%) | 12 (7.1%) | 6 (16.7%) | |
| >50% | 40 (19.6%) | 38 (22.6%) | 2 (5.6%) | |
| SAQ-7 score, mean ± SD | 91.86 ± 4.44 | 92.29 ± 3.03 | 89.84 ± 8.09 | <0.001 |
| Fair: SAQ-7 score (≤50), n (%) | 0 (0%) | 0 (0%) | 0 (0%) | 0.086 |
| Good: SAQ-7 score (51–75), n (%) | 4 (2%) | 2 (1.2%) | 2 (5.6%) | |
| Excellent: SAQ-7 score (76–100), n (%) | 200 (98%) | 166 (98.8%) | 34 (94.4%) | |
| Key: CABG = coronary artery bypass grafting; CVA = cerebral vascular accident; LVEDP = left ventricular end-diastolic pressure; LVEF = left ventricular ejection fraction; SAQ = Seattle Angina Questionnaire; SD = standard deviation | ||||
Table 4. Major adverse cardiovascular events (MACE) at 30 days and 3 months for patients with and without elevated LVEDP after primary PCI
| Total | Post-procedure LVEDP | p value | ||
|---|---|---|---|---|
| <19 mmHg | ≥19 mmHg | |||
| Total, N (%) | 318 | 252 (79.2%) | 66 (20.8%) | |
| 30-day outcome | ||||
| Lost to follow-up | 70 (22%) | 58 (23%) | 12 (18.2%) | 0.194 |
| No | 232 (73%) | 184 (73%) | 48 (72.7%) | |
| Yes | 16 (5%) | 10 (4%) | 6 (9.1%) | |
| In-hospital mortality | 12 (75%) | 6 (60%) | 6 (100%) | – |
| Post-discharge mortality | 0 (0%) | 0 (0%) | 0 (0%) | |
| Hospitalisation due to HF | 2 (12.5%) | 2 (20%) | 0 (0%) | |
| Repeat revascularisation | 2 (12.5%) | 2 (20%) | 0 (0%) | |
| Re-infarction/MI | 0 (0%) | 0 (0%) | 0 (0%) | |
| 3-month MACE, n (%) | ||||
| Lost to follow-up | 98 (30.8%) | 78 (31%) | 20 (30.3%) | <0.001 |
| No | 192 (60.4%) | 160 (63.5%) | 32 (48.5%) | |
| Yes | 28 (8.8%) | 14 (5.6%) | 14 (21.2%) | |
| In-hospital mortality | 12 (42.9%) | 6 (42.9%) | 6 (42.9%) | – |
| Post-discharge mortality | 4 (14.3%) | 0 (0%) | 4 (28.6%) | |
| Hospitalisation due to HF | 6 (21.4%) | 4 (28.6%) | 2 (14.3%) | |
| Repeat revascularisation | 4 (14.3%) | 4 (28.6%) | 0 (0%) | |
| Re-infarction/MI | 2 (7.1%) | 0 (0%) | 2 (14.3%) | |
| Key: HF = heart failure; LVEDP = left ventricular end-diastolic pressure; MACE = major adverse cardiovascular event; MI = myocardial infarction | ||||
Discussion
The LVEDP measures total left ventricular function; it has been observed to be a significant marker of prognosis after acute myocardial infarction. In this study, we evaluated the change in LVEDP after primary PCI in patients with STEMI, and the association of post-procedure elevated LVEDP with quality of life and short-term major adverse outcomes. In summary, an improvement (decline of at least 1 mmHg) in LVEDP was observed in a significant number of patients after primary PCI. However, post-procedure elevated LVEDP manifestation of clinically adverse characteristics was found to be associated with male gender, Killip class II/III at presentation, total occlusion of the culprit artery with pre-procedure TIMI flow grade 0 and MBG grade 0, mainly culprit left anterior descending artery, elevated pre-procedure LVEDP and reduced LVEF. The post-procedure elevated LVEDP was observed to be associated with an increased risk of in-hospital, as well as 30-day and three-month MACE, including all-cause mortality. It has also been associated with a decreased quality of life after three months of primary PCI.
The findings of an increased incidence of MACE during the short-term follow-up after primary PCI of patients with baseline or post-procedure elevated LVEDP are not new to our study. Multiple studies have reported similar observations.7–12 However, poor quality of life among MACE-free patients with post-procedure LVEDP is a point of concern in these patients. Multiple studies have taken both LVEDP (diastolic dysfunction) and LVEF (systolic dysfunction) for the prediction of the short- and long-term fate of patients after primary PCI. A study conducted by Ndrepepa et al.13 reported a ratio of LVEF/LVEDP as an independent and significant predictor of long-term (eight-year) mortality after primary PCI. This ratio has also proved a significant prognostic marker for the prediction of MACE during 43 ± 31 months follow-up after STEMI.8 A LVEDP of >22 mmHg measured during primary PCI is found to be associated with an increased risk of mortality, congestive heart failure, and cardiogenic shock at 90 days after primary PCI.14 Similar to these findings, Planer et al.6 also reported baseline elevated LVEDP as an independent predictor of adverse outcomes on a short- and long-term basis. The association of elevated LVEDP with reduced myocardial salvage and the extent of the ischaemia can be a possible mechanism behind an increased risk of adverse outcomes in patients with STEMI.11 Another index, derived as the ratio of systolic blood pressure to LVEDP, is reported to be an independent predictor of in-hospital mortality at the critical cut-off of ≤4.15 Another combination of criteria of LVEDP >18 mmHg and index of microcirculatory resistance >32 has been found to have added advantage for detecting MACE among patients undergoing primary PCI.10 Two of the recent studies from our population reported the prognostic role of elevated LVEDP. The first by Kumar et al.1 reported LVEDP ≥20 mmHg as an independent predictor of short-term MACE after primary PCI with an adjusted hazard ratio (HR) of 1.81 (95%CI 1.3 to 2.51). The second study by Ammar et al.16 reported LVEDP of ≥20 mmHg as an essential predictor of contrast-induced acute kidney injury after primary PCI, especially in patients with a LVEF ≤40%.
Similar to our finding regarding clinical co-variates of elevated LVEDP, Zhou et al.17 reported that patients with elevated LVEDP had more frequently descending branches as infarct-related arteries, along with the larger left atrial end-systolic and diastolic diameter, higher levels of myocardial necrosis, regional wall motion abnormality, and small ejection fraction, along with the higher incidence of mortality and heart failure. Another study reported a significant relationship between elevated LVEDP and wire-crossing time among patients undergoing primary PCI.18 Very limited data are available regarding the effective treatment options for reducing elevated LVEDP. In a study by Khan et al.,9 the administration of furosemide along with glyceryl trinitrate was a safe and effective strategy for reducing LVEDP in STEMI patients. Similar to our findings of the decline of only 1.65 ± 4.35 mmHg, a study conducted by Khan et al.7 too reported a marginal drop in LVEDP from 18 (interquartile range [IQR] 12 to 22 mmHg) pre-procedure to 15 (IQR 10 to 20 mmHg) post-procedure.
Even though this is the first study of its kind in the Pakistani population, some limitations have to be acknowledged, which included single-centre coverage, the observational nature of the study, the small sample size, and a high rate of loss to follow-up. Large-scale multi-centre studies are warranted to understand the prognostic role of LVEDP, and its association with the quality of life of patients on a long-term basis.
Conclusion
In conclusion, LVEDP declined acutely in a significant number of patients after primary PCI, but the quantum of decline was mostly marginal. Post-procedure elevated LVEDP was found to be associated with poor quality of life and an increased risk of immediate and short-term MACE. Further studies are required to formulate effective strategies for reducing LVEDP levels to minimise its detrimental effects on short- and long-term outcomes after primary PCI.
Key messages
- Left ventricular end-diastolic pressure (LVEDP) declined acutely in a significant number of patients after primary percutaneous coronary intervention (PCI), but the quantum of decline was mainly marginal
- Post-procedure elevated LVEDP was found to be associated with poor quality of life and an increased risk of immediate and short-term major adverse cardiovascular events (MACE)
- Further studies are required to formulate effective strategies for reducing LVEDP levels to minimise its detrimental effects on short- and long-term outcomes after primary PCI
Conflicts of interest
None declared.
Funding
None.
Study approval
This study was approved by the ethical review committee (ERC) of the National Institute of Cardiovascular Diseases (NICVD), Karachi (ERC-121/2021). Verbal informed consent was obtained from all the patients regarding their participation in the study and publication of data, while maintaining confidentiality and anonymity. Due to the observational nature of the study, ERC waived the written consent and verbal consents were approved by the ERC.
Acknowledgement
The authors wish to acknowledge the support of the staff members of the Clinical Research Department of the NICVD, Karachi, Pakistan.
References
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