Advertisement

Impact of Left Ventricular End-Diastolic Pressure on the Outcomes of Patients Undergoing Percutaneous Coronary Intervention

Published:October 07, 2022DOI:https://doi.org/10.1016/j.amjcard.2022.09.007
      Left ventricular end-diastolic pressure (LVEDP) is an important hemodynamic marker of left ventricular performance and affects coronary perfusion. We evaluated the association of LVEDP with patient outcomes after elective or urgent percutaneous coronary intervention (PCI). We included n = 49,600 patients undergoing elective or urgent PCI. Patients were divided according to LVEDP tertile for descriptive analysis. The primary end point was in-hospital mortality. A recursive partitioning tree model for mortality was built to guide decision-making in patients with high LVEDP undergoing nonemergent PCI. Overall, n = 18,099 patients had an LVEDP <13 mm Hg, n = 15,416 had an LVEDP 13 to 18 mm Hg, and n = 16,085 had an LVEDP >18 mm Hg. Patients in the high LVEDP tertile had a worse clinical and angiographic/procedural profile and experienced a higher incidence of in-hospital post-PCI adverse outcomes, including death (LVEDP <13 mm Hg 0.3% vs LVEDP 13 to 18 mm Hg 0.4% vs LVEDP >18 mm Hg 0.8%, p <0.001). An elevated LVEDP was an independent predictor of adverse outcomes including mortality. An LVEDP ≥26 mm Hg was identified as a marker of high mortality (1.5%) in patients who underwent elective PCI, with rates varying from 0.5% to 10.4%, based upon a clinical profile defined by hemoglobin, systolic blood pressure, renal and left ventricular function, and atrial fibrillation. In conclusion, an elevated LVEDP is observed in 1/3 of the patients who underwent elective or urgent PCI and is associated with higher rates of in-hospital adverse outcomes, including death. Patients with an LVEDP ≥26 mm Hg who underwent elective PCI had markedly higher mortality rates, suggesting that such patients may warrant further optimization before PCI.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to American Journal of Cardiology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Kern MJ
        • Christopher T.
        Hemodynamic rounds series II: the LVEDP.
        Cathet Cardiovasc Diagn. 1998; 44: 70-74
        • Planer D
        • Mehran R
        • Witzenbichler B
        • Guagliumi G
        • Peruga JZ
        • Brodie BR
        • Dudek D
        • Möckel M
        • Reyes SL
        • Stone GW.
        Prognostic utility of left ventricular end-diastolic pressure in patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention.
        Am J Cardiol. 2011; 108: 1068-1074
        • Ndrepepa G
        • Cassese S
        • Emmer M
        • Mayer K
        • Kufner S
        • Xhepa E
        • Fusaro M
        • Laugwitz KL
        • Schunkert H
        • Kastrati A.
        Relation of ratio of left ventricular ejection fraction to left ventricular end-diastolic pressure to long-term prognosis after ST-segment elevation acute myocardial infarction.
        Am J Cardiol. 2019; 123: 199-205
        • Bagai A
        • Armstrong PW
        • Stebbins A
        • Mahaffey KW
        • Hochman JS
        • Weaver WD
        • Patel MR
        • Granger CB
        • Lopes RD.
        Prognostic implications of left ventricular end-diastolic pressure during primary percutaneous coronary intervention for ST-segment elevation myocardial infarction: findings from the Assessment of pexelizumab in acute myocardial infarction study.
        Am Heart J. 2013; 166: 913-919
        • Leistner DM
        • Dietrich S
        • Erbay A
        • Steiner J
        • Abdelwahed Y
        • Siegrist PT
        • Schindler M
        • Skurk C
        • Haghikia A
        • Sinning D
        • Riedel M
        • Landmesser U
        • Stähli BE.
        Association of left ventricular end-diastolic pressure with mortality in patients undergoing percutaneous coronary intervention for acute coronary syndromes.
        Catheter Cardiovasc Interv. 2020; 96: E439-E446
        • Buchanan KD
        • Kolm P
        • Iantorno M
        • Gajanana D
        • Rogers T
        • Gai J
        • Torguson R
        • Ben-Dor I
        • Suddath WO
        • Satler LF
        • Waksman R.
        Coronary perfusion pressure and left ventricular hemodynamics as predictors of cardiovascular collapse following percutaneous coronary intervention.
        Cardiovasc Revasc Med. 2019; 20: 11-15
        • Kline-Rogers E
        • Share D
        • Bondie D
        • Rogers B
        • Karavite D
        • Kanten S
        • Wren P
        • Bodurka C
        • Fisk C
        • McGinnity J
        • Wright S
        • Fox S
        • Eagle KA
        • Moscucci M
        Blue Cross Blue Shield of Michigan Cardiovascular Consortium (BMC2). Development of a multicenter interventional cardiology database: the Blue Cross Blue Shield of Michigan Cardiovascular Consortium (BMC2) experience.
        J Interv Cardiol. 2002; 15: 387-392
        • Kopin D
        • Seth M
        • Sukul D
        • Dixon S
        • Aronow HD
        • Lee D
        • Tucciarone M
        • Pielsticker E
        • Gurm HS.
        Primary and secondary vascular access site complications associated with percutaneous coronary intervention: insights from the BMC2 Registry.
        JACC Cardiovasc Interv. 2019; 12: 2247-2256
        • Levine GN
        • Bates ER
        • Blankenship JC
        • Bailey SR
        • Bittl JA
        • Cercek B
        • Chambers CE
        • Ellis SG
        • Guyton RA
        • Hollenberg SM
        • Khot UN
        • Lange RA
        • Mauri L
        • Mehran R
        • Moussa ID
        • Mukherjee D
        • Nallamothu BK
        • Ting HH
        2011 ACCF/AHA/SCAI Guideline for percutaneous coronary intervention: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines and the Society for Cardiovascular Angiography and Interventions.
        Circulation. 2011; 124: e574-e651
        • Ybarra LF
        • Rinfret S
        • Brilakis ES
        • Karmpaliotis D
        • Azzalini L
        • Grantham JA
        • Kandzari DE
        • Mashayekhi K
        • Spratt JC
        • Wijeysundera HC
        • ໿Ali ZA
        • Buller CE
        • Carlino M
        • Cohen DJ
        • Cutlip DE
        • De Martini T
        • Di Mario C
        • Farb A
        • Finn AV
        • Galassi AR
        • Gibson CM
        • Hanratty C
        • Hill JM
        • Jaffer FA
        • Krucoff MW
        • Lombardi WL
        • Maehara A
        • Magee PFA
        • Mehran R
        • Moses JW
        • Nicholson WJ
        • Onuma Y
        • Sianos G
        • Sumitsuji S
        • Tsuchikane E
        • Virmani R
        • Walsh SJ
        • Werner GS
        • Yamane M
        • Stone GW
        • Rinfret S
        • Stone GW
        Chronic Total Occlusion Academic Research Consortium. Definitions and clinical trial design principles for coronary artery chronic total occlusion therapies: CTO-ARC consensus recommendations.
        Circulation. 2021; 143: 479-500
        • Gurm HS
        • Dixon SR
        • Smith DE
        • Share D
        • Lalonde T
        • Greenbaum A
        • Moscucci M
        BMC2 (Blue Cross Blue Shield of Michigan Cardiovascular Consortium) Registry. Renal function-based contrast dosing to define safe limits of radiographic contrast media in patients undergoing percutaneous coronary interventions.
        J Am Coll Cardiol. 2011; 58: 907-914
        • Tibshirani R.
        The LASSO method for variable selection in the Cox model.
        Stat Med. 1997; 16: 385-395
        • Friedman J
        • Hastie T
        • Tibshirani R.
        Regularization paths for generalized linear models via coordinate descent.
        J Stat Softw. 2010; 33: 1-22
        • Claeys MJ
        • Bosmans J
        • Veenstra L
        • Jorens P
        • De RaedtH Vrints CJ
        Determinants and prognostic implications of persistent ST-segment elevation after primary angioplasty for acute myocardial infarction: importance of microvascular reperfusion injury on clinical outcome.
        Circulation. 1999; 99: 1972-1977
        • Liu C
        • Caughey MC
        • Smith SCJ
        • Dai X.
        Elevated left ventricular end diastolic pressure is associated with increased risk of contrast-induced acute kidney injury in patients undergoing percutaneous coronary intervention.
        Int J Cardiol. 2020; 306: 196-202
        • Azzalini L.
        Left ventricular end-diastolic pressure and contrast-induced acute kidney injury: a new chapter of the cardio-renal saga.
        Int J Cardiol. 2020; 306: 206-208
        • Valle JA
        • Mccoy LA
        • Maddox TM
        • Rumsfeld JS
        • Ho PM
        • Casserly IP
        • Nallamothu BK
        • Roe MT
        • Tsai TT
        • Messenger JC.
        Longitudinal risk of adverse events in patients with acute kidney injury after percutaneous coronary intervention: insights from the National cardiovascular Data Registry.
        Circ Cardiovasc Interv. 2017; 10e004439
        • Park SM
        • Ahn CM
        • Hong SJ
        • Kim YH
        • Park JH
        • Shim WJ
        • Lim DS.
        Acute changes of left ventricular hemodynamics and function during percutaneous coronary intervention in patients with unprotected left main coronary artery disease.
        Heart Vessels. 2015; 30: 432-440