Buchanan Kyle D, Kolm Paul, Iantorno Micaela, Gajanana Deepakraj, Rogers Toby, Gai Jiaxiang, Torguson Rebecca, Ben-Dor Itsik, Suddath William O, Satler Lowell F, Waksman Ron
Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, United States of America.
Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, United States of America; Cardiovascular Branch, Division of Intramural Research, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MD, United States of America.
Cardiovasc Revasc Med. 2019 Jan;20(1):11-15. doi: 10.1016/j.carrev.2018.09.005. Epub 2018 Sep 10.
BACKGROUND/PURPOSE: Appropriate patient selection for mechanical circulatory support following percutaneous coronary intervention (PCI) remains a challenge. This study aims to evaluate the role of coronary perfusion pressure and other left ventricular hemodynamics to predict cardiovascular collapse following PCI.
METHODS/MATERIALS: We retrospectively analyzed all patients who underwent PCI for acute coronary syndrome (ACS) from 2003 to 2016. Coronary perfusion pressure was calculated for each patient and defined as the difference in mean arterial pressure and left ventricular end diastolic pressure (LVEDP). Logistic regression analysis was performed to determine predictor of composite outcome of in-hospital mortality, myocardial infarction (MI), congestive heart failure (CHF), and cardiogenic shock.
Nine hundred twenty-two patients were analyzed. Two-hundred twenty-eight (25%) presented with ST-elevation MI (STEMI) while 694 (75%) underwent PCI for unstable angina or non-Q-wave MI. The mean LVEDP was significantly higher in the STEMI patients (24 ± 9 vs. 19 ± 8 mm Hg, p < 0.05) and perfusion pressure significantly lower (68 ± 24 vs. 74 ± 18 mm Hg, p < 0.05). Eighty-seven (9.4%) reached the composite endpoint, and there was no difference between the STEMI and Not-STEMI groups. Neither LVEDP nor coronary perfusion pressure was a predictor of the composite outcome following multivariable logistic regression analysis for either STEMI or Not-STEMI patients. Increasing age, chronic renal insufficiency (CRI), CHF, and low left ventricular ejection fraction were predictors of the composite outcome for Not-STEMI patients, whereas only history of cerebrovascular accident and CRI were predictors for STEMI patients.
In hemodynamically stable patients presenting with ACS, LVEDP and coronary perfusion pressure are not predictive of in-hospital cardiovascular collapse.
The authors retrospectively analyzed 922 patients from a single center who underwent percutaneous coronary intervention (PCI) for acute coronary syndromes to evaluate the role of coronary perfusion pressure and other left ventricular hemodynamics to predict cardiovascular collapse following PCI. They found that neither coronary perfusion pressure nor left ventricular end diastolic pressure was predictive of in-hospital cardiovascular collapse.
背景/目的：经皮冠状动脉介入治疗（PCI）后机械循环支持的合适患者选择仍然是一项挑战。本研究旨在评估冠状动脉灌注压和其他左心室血流动力学指标在预测PCI后心血管衰竭中的作用。
方法/材料：我们回顾性分析了2003年至2016年期间因急性冠状动脉综合征（ACS）接受PCI的所有患者。计算每位患者的冠状动脉灌注压，定义为平均动脉压与左心室舒张末期压力（LVEDP）之差。进行逻辑回归分析以确定住院死亡率、心肌梗死（MI）、充血性心力衰竭（CHF）和心源性休克复合结局的预测因素。
共分析了922例患者。其中228例（25%）为ST段抬高型心肌梗死（STEMI），694例（75%）因不稳定型心绞痛或非Q波心肌梗死接受PCI。STEMI患者的平均LVEDP显著更高（24±9 vs. 19±8 mmHg，p<0.05），而灌注压显著更低（68±24 vs. 74±18 mmHg，p<0.05）。87例（9.4%）达到复合终点，STEMI组和非STEMI组之间无差异。对于STEMI或非STEMI患者，多变量逻辑回归分析后，LVEDP和冠状动脉灌注压均不是复合结局的预测因素。年龄增加、慢性肾功能不全（CRI）、CHF和左心室射血分数降低是非STEMI患者复合结局的预测因素，而对于STEMI患者，只有脑血管意外病史和CRI是预测因素。
在血流动力学稳定的ACS患者中，LVEDP和冠状动脉灌注压不能预测住院期间的心血管衰竭。
作者回顾性分析了来自单一中心的922例因急性冠状动脉综合征接受经皮冠状动脉介入治疗（PCI）的患者，以评估冠状动脉灌注压和其他左心室血流动力学指标在预测PCI后心血管衰竭中的作用。他们发现冠状动脉灌注压和左心室舒张末期压力均不能预测住院期间的心血管衰竭。
