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

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Conference Proceeding - Restricted Access

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Journal of the American College of Cardiology


Background: Left ventricular end-diastolic pressure (LVEDP) is an important hemodynamic marker of left ventricular performance and affects coronary perfusion. We aimed to evaluate the association of LVEDP with patient outcomes after elective or urgent percutaneous coronary intervention (PCI). Methods: We included 34,555 patients undergoing 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. Results: A total of 12,546 patients had an LVEDP Hg, 10,607 had an LVEDP 13-18 mm Hg, and 11,402 had an LVEDP >18 mm Hg. Patients in the high-LVEDP tertile had worse clinical and angiographic/procedural profiles and experienced a higher incidence of in-hospital post-PCI adverse outcomes, including death (0.4% for LVEDP Hg, 0.5% for LVEDP 13-18 mm Hg, and 1.1% for LVEDP >18 mm Hg; P < 0.001). An elevated LVEDP was an independent predictor of adverse outcome including mortality after adjusting for patient differences. An LVEDP ≥27 mm Hg was identified as a marker of high mortality (2.1%), with rates varying from 1.1% to 38.7%, based on a clinical profile defined by cardiogenic shock, renal and left ventricular function, hemoglobin, and systolic blood pressure. Conclusion: An elevated LVEDP was observed in one-third of patients undergoing elective or urgent PCI and was associated with higher rates of in-hospital adverse outcomes, including death. Patients with an LVEDP ≥27 mm Hg undergoing elective PCI had markedly higher mortality rates, suggesting that such patients may warrant further optimization before PCI.





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