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Randomized Controlled Trial
. 2021 May 17;21(1):243.
doi: 10.1186/s12872-021-02046-x.

Natural history and prognostic implications of left ventricular end-diastolic pressure in reperfused ST-segment elevation myocardial infarction: an analysis of the thrombolysis in myocardial infarction (TIMI) II randomized controlled trial

Arshad A Khan  1   2   3 , Mohammed S Al-Omary  1   2   3 , Nicholas J Collins  1   2   3 , John Attia  1   2   3 , Andrew J Boyle  4   5   6
Affiliations
Randomized Controlled Trial

Natural history and prognostic implications of left ventricular end-diastolic pressure in reperfused ST-segment elevation myocardial infarction: an analysis of the thrombolysis in myocardial infarction (TIMI) II randomized controlled trial

Arshad A Khan et al. BMC Cardiovasc Disord. .

Abstract

Background: 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.

Methods: 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.

Results: 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.

Conclusions: 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.

Keywords: Left ventricular end diastolic pressure; ST-segment elevation myocardial infarction.

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Conflict of interest statement

Author’s declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Flow chart demonstrating recruiting to Thrombolysis in Myocardial Infarction (TIMI) II study and the current analysis
Fig. 2
Fig. 2
All-cause mortality and heart failure admissions for the whole cohort and for patients with left ventricular ejection fraction ≥ 40%. Outcomes for whole cohort and for patients with LVEF > 40%
Fig. 3
Fig. 3
Correlation between left ventricular ejection fraction and left ventricular end-diastolic pressure. For 2% decrease in LVEF, there was 10 mmHg rise in LVEDP (R2 = 0.07, P < 0.01). Relationship between LVEDP and LVEF. LVEDP left ventricular end-diastolic pressure, LVEF left ventricular ejection fraction
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