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Elevated left ventricular end-diastolic pressure (LVEDP) has been shown to predict adverse outcomes in patients with ST elevation myocardial infarction. However, the prognostic value of elevated LVEDP in patients with non-ST elevation myocardial infarction (NSTEMI) has not been fully elucidated.
We performed a retrospective analysis of 481 consecutive patients presenting with NSTEMI who underwent coronary angiography within five days after presentation from January 2013 to June 2014. LVEDP was measured during the index cardiac catheterization. Patients without LVEDP data were excluded. Patients were categorized into an elevated LVEDP group and control group. Baseline and angiographic characteristics, in-hospital revascularization procedures as well as in-hospital and 30-day major adverse cardiac event (MACE) including death, recurrent myocardial infarction, and target vessel revascularization were compared between the two groups.
LVEDP was measured in 367 patients. The median LVEDP was 19.0 mm Hg (interquartile; 14.0, 24.0 mmHg). By receiver operating characteristic curve analysis, the optimal cutoff value in predicting in-hospital MACE was 22 mmHg (area under the curve was 0.80). As a result, 109 patients (29.7%) were categorized into the elevated LVEDP group. Patients with elevated LVEDP were more likely to have hypertension (79.8% vs. 69.0%, p=0.03) and diabetes mellitus (50.5% vs. 32.9%, p=0.002). There was no significant difference in the rates of multivessel disease, impaired coronary blood flow, in-hospital percutaneous coronary intervention and coronary artery bypass grafting. Patients with elevated LVEDP had a higher rate of in-hospital heart failure (22.0% vs. 13.2%, p=0.03), in-hospital MACE (4.6% vs. 0.4%, p=0.01) as well as 30-day MACE (8.3% vs. 2.7%, p=0.02) compared with the control group. There was no significant difference in the rates of in-hospital heart failure, and in-hospital and 30-day MACE between those with and without LVEDP measurements.
Elevated LVEDP was significantly associated with a higher rate of in-hospital heart failure, in-hospital MACE and 30-day MACE in patients with NSTEMI.