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医学
心脏病学
内科学
心肌梗塞
经皮冠状动脉介入治疗
危险系数
传统PCI
心室压
置信区间
血流动力学
作者
Gjin Ndrepepa,Salvatore Cassese,Desard Hashorva,Sebastian Kufner,Erion Xhepa,E Hasimi,Massimiliano Fusaro,Karl-Ludwig Laugwitz,Heribert Schunkert,Adnan Kastrati
摘要
Objectives We aimed to assess the association of left ventricular end-diastolic pressure (LVEDP) with myocardial salvage and long-term mortality in ST-segment elevation myocardial infarction (STEMI) patients undergoing primary percutaneous coronary intervention (PCI). Background The association of LVEDP with myocardial salvage or long-term mortality in patients with STEMI has not been investigated. Methods This study included 1,312 patients with STEMI undergoing primary PCI between 2002 and 2007. LVEDP was measured at the time of intervention. Patients were divided into three groups: a group with LVEDP in the 1st tertile (LVEDP, 4–19 mmHg; n = 496), a group with LVEDP in the 2nd tertile (LVEDP >19–24 mmHg; n = 410) and a group with LVEDP in the 3rd tertile (LVEDP >24–45 mmHg; n = 406). The primary outcome was 8-year cardiac mortality. Results The primary outcome (cardiac deaths) occurred in 114 patients. Deaths occurred in 26 (7.9%), 36 (11.5%), and 52 (16.4%) patients with LVEDP in the 1st to 3rd tertiles, respectively (adjusted hazard ratio = 1.18, 95% confidence interval 1.02–1.36, P = 0.022, for 5 mmHg increment in the LVEDP values). LVEDP correlated with the extent of myocardial ischemia (R = 0.351; P < 0.001). In patients with LVEDP in the 1st to 3rd tertiles, the salvage index (proportion of initial area at risk salvaged) was 0.53 [0.27–0.84], 0.53 [0.28–0.80], and 0.43 [0.18–0.75], respectively (P = 0.012). After adjustment, LVEDP correlated inversely with myocardial salvage (P < 0.001). Conclusions In patients with STEMI, elevated LVEDP correlated with the extent of myocardial ischemia, reduced myocardial salvage and increased risk of 8-year cardiac mortality.
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