Ratio of systolic blood pressure to left ventricular end‐diastolic pressure at the time of primary percutaneous coronary intervention predicts in‐hospital mortality in patients with ST‐elevation myocardial infarction

Objective To determine the ability of simple hemodynamic parameters obtained at the time of cardiac catheterization to predict in‐hospital mortality following ST‐elevation myocardial infarction (STEMI). Background Hemodynamic parameters measured at the time of primary percutaneous coronary intervention (PPCI) could potentially identify high‐risk patients who would benefit from aggressive hemodynamic support in the Cardiac Catheterization laboratory. Methods This is a retrospective single‐center study of 219 consecutive patients with STEMI. Left ventricular end‐diastolic pressure (LVEDP), systolic blood pressure (SBP), and aortic diastolic blood pressure were obtained after successful revascularization. The prognostic ability of LVEDP, pulse pressure, and SBP/LVEDP ratio were compared to major mortality risk scores. Results Patients had a mean age of 60 ±14 years, were predominantly white (73%), male (64%), with anterior wall infarcts in 39%. Comorbidities included diabetes mellitus (27%), heart failure (9%), and chronic kidney disease (7%). In‐hospital mortality was 9%. Patients with SBP/LVEDP ≤ 4 had increased risk of in‐hospital death (32% vs. 5.3%, P < 0.0001), intra‐aortic balloon pump (IABP) usage (51.6% vs. 9.6%, P < 0.0001) and combined endpoint of death or IABP usage (58.1% vs. 13.3%, P < 0.0001) compared to patients with SBP/LVEDP > 4. The area under curve (AUC) for SBP/LVEDP ratio for in‐hospital mortality (0.69) was more predictive than LVEDP (0.61, P = 0.04) or pulse pressure (0.55, P = 0.02) but similar to Shock Index (ratio of heart rate to SBP) and Modified Shock Index (ratio of HR to mean arterial pressure). Conclusion An SBP/LVEDP ratio ≤ 4 identified a group of STEMI patients at high risk of in‐hospital death. © 2017 Wiley Periodicals, Inc.