Department of Cardiovascular Medicine, John Hunter Hospital, Locked Bag 1, HRMC, Newcastle, NSW, 2310, Australia.
The University of Newcastle, Newcastle, Australia.
BMC Cardiovasc Disord. 2021 May 17;21(1):243. doi: 10.1186/s12872-021-02046-x.
The aim of the current study is to assess the natural history and prognostic value of elevated left ventricular end-diastolic pressure (LVEDP) in patients with ST-segment elevation myocardial infarction (STEMI) after reperfusion with thrombolysis; we utilize data from the Thrombolysis in Myocardial Infarction (TIMI) II study.
A total of 3339 patients were randomized to either an invasive (n = 1681) or a conservative (n = 1658) strategy in the TIMI II study following thrombolysis. To make the current cohort as relevant as possible to modern pharmaco-invasively managed cohorts, patients in the invasive arm with TIMI flow grade ≥ 2 (N = 1201) at initial catheterization are included in the analysis. Of these, 259 patients had a second catheterization prior to hospital discharge, and these were used to define the natural history of LVEDP in reperfused STEMI.
The median LVEDP for the whole cohort was 18 mmHg (IQR: 12-23). Patients were divided into quartiles by LVEDP measured during the first cardiac catheterization. During a median follow up of 3 (IQR: 2.1-3.2) years, quartile 4 (highest LVEDP) had the highest incidence of mortality and heart failure admissions. In the cohort with paired catheterization data, the LVEDP dropped slightly from 18 mmHg (1QR: 12-22) to 15 mmHg (IQR: 10-20) (p = 0.01) from the first to the pre-hospital discharge catheterization.
LVEDP remains largely stable during hospitalisation post-STEMI. Elevated LVEDP is a predictor of death and heart failure hospitalization in STEMI patients undergoing successful thrombolysis.
本研究旨在评估溶栓再灌注后 ST 段抬高型心肌梗死（STEMI）患者左心室舒张末期压（LVEDP）升高的自然史和预后价值；我们利用来自心肌梗死溶栓治疗（TIMI） II 研究的数据。
TIMI II 研究中，共有 3339 例患者随机分为介入（n = 1681）或保守（n = 1658）策略。为了使当前队列尽可能与现代药物介入管理的队列相关，初始导管检查时 TIMI 血流分级 ≥ 2 的介入组患者（n = 1201）纳入分析。其中，259 例患者在出院前进行了第二次导管检查，这些数据用于定义再灌注 STEMI 中 LVEDP 的自然史。
全队列的 LVEDP 中位数为 18mmHg（IQR：12-23）。根据第一次心脏导管检查时测量的 LVEDP 将患者分为四组。在中位随访 3（IQR：2.1-3.2）年期间，LVEDP 最高的第四组（最高四分位组）死亡率和心力衰竭入院率最高。在具有配对导管数据的队列中，LVEDP 从第一次导管检查时的 18mmHg（IQR：12-22）略微下降至出院前导管检查时的 15mmHg（IQR：10-20）（p = 0.01）。
STEMI 患者溶栓再灌注后住院期间 LVEDP 基本保持稳定。LVEDP 升高是 STEMI 患者死亡和心力衰竭住院的预测因子。
