title: The value of novel invasive hemodynamic parameters added to the TIMI risk score for short-term prognosis assessment in patients with ST segment elevation myocardial infarction.
abstract: BACKGROUND
  We compared the prognostic capacity of conventional and novel invasive parameters derived from the slope of the preload recruitable stroke work relationship (PRSW) in STEMI patients and assessed their contribution to the TIMI risk score.
  
  
  METHODS
  Left ventricular end-diastolic pressure (EDP), ejection fraction (EF), pressure adjusted maximum rate of pressure change in the left ventricle (dP/dt/P), aortic systolic pressure to EDP ratio (SBP/EDP) and end-diastolic volume adjusted stroke work (EW), derived from the slope of the PRSW relationship, were obtained during the emergency cardiac catheterization in 523 STEMI patients. The predictive power of the analyzed parameters for 30-day and 1-year mortality was evaluated using C-statistics and reclassification analysis was adopted to assess the improvement in TIMI score.
  
  
  RESULTS
  The highest area under the curve (AUC) values for 30-day mortality were observed for EW (0.872(95% confidence interval 0.801-0.943)), SBP/EDP (0.843(0.758-0.928)) and EF (0.833(0.735-0.931)); p<0.001 for all values. For 1-year mortality the best predictive value was found for EW (0.806(0.724-0.887) and EF (0.793(0.703-0.883)); p<0.001 for both. The addition of EDP, SBP/EDP ratio and EW to TIMI score significantly increased the AUC according to De Long's test. For 30-day mortality, increased discriminative power following addition to the TIMI score was observed for EW and SBP/EDP (Integrated Discrimination Improvement was 0.086(0.033-0.140), p=0.002 and 0.078(0.028-0.128), p=0.002, respectively).
  
  
  CONCLUSIONS
  EW and SBP/EDP are prognostic markers with high predictive value for 30-day and 1-year mortality. Both parameters, easily obtained during emergency catheterization, improve the discriminatory capacity of the TIMI score for 30-day mortality.
authors.affiliation: Department of Internal Medicine and Cardiology, University Hospital Brno, Brno, Czech Republic; Faculty of Medicine, Masaryk University, Brno, Czech Republic; Hospital Trebic, Trebic, Czech Republic.
authors.forename: Martin
authors.initials: M
authors.lastname: Tesak
authors.affiliation: Department of Internal Medicine and Cardiology, University Hospital Brno, Brno, Czech Republic; Faculty of Medicine, Masaryk University, Brno, Czech Republic.
authors.forename: Petr
authors.initials: P
authors.lastname: Kala
authors.affiliation: Institute of Biostatistics and Analyses, Faculty of Medicine, Masaryk University, Brno, Czech Republic.
authors.forename: Jiri
authors.initials: J
authors.lastname: Jarkovsky
authors.affiliation: Department of Internal Medicine and Cardiology, University Hospital Brno, Brno, Czech Republic; Faculty of Medicine, Masaryk University, Brno, Czech Republic.
authors.forename: Martin
authors.initials: M
authors.lastname: Poloczek
authors.affiliation: Department of Internal Medicine and Cardiology, University Hospital Brno, Brno, Czech Republic; Faculty of Medicine, Masaryk University, Brno, Czech Republic.
authors.forename: Otakar
authors.initials: O
authors.lastname: Bocek
authors.affiliation: Department of Internal Medicine and Cardiology, University Hospital Brno, Brno, Czech Republic.
authors.forename: Petr
authors.initials: P
authors.lastname: Jerabek
authors.affiliation: Department of Internal Medicine and Cardiology, University Hospital Brno, Brno, Czech Republic.
authors.forename: Lenka
authors.initials: L
authors.lastname: Kubková
authors.affiliation: Department of Internal Medicine and Cardiology, University Hospital Brno, Brno, Czech Republic.
authors.forename: Jan
authors.initials: J
authors.lastname: Manousek
authors.affiliation: Department of Internal Medicine and Cardiology, University Hospital Brno, Brno, Czech Republic; Faculty of Medicine, Masaryk University, Brno, Czech Republic; International Clinical Research Center, Department of Cardiovascular Disease, University Hospital St Anne's, Brno, Czech Republic.
authors.forename: Jindrich
authors.initials: J
authors.lastname: Spinar
authors.affiliation: INSERM UMR-S 942, Department of Anaesthesiology and Critical Care Medicine, Lariboisière University Hospital, AP-HP University Paris Diderot, Paris, France; Cardiac Diseases and Biomarkers Unit, INSERM UMR-S 942, Department of Cardiology, Lariboisière University Hospital Paris, France.
authors.forename: Alexandre
authors.initials: A
authors.lastname: Mebazaa
authors.affiliation: Department of Internal Medicine and Cardiology, University Hospital Brno, Brno, Czech Republic; Faculty of Medicine, Masaryk University, Brno, Czech Republic; International Clinical Research Center, Department of Cardiovascular Disease, University Hospital St Anne's, Brno, Czech Republic. Electronic address: jiri.parenica@atlas.cz.
authors.forename: Jiri
authors.initials: J
authors.lastname: Parenica
authors.affiliation: INSERM UMR-S 942, Department of Anaesthesiology and Critical Care Medicine, Lariboisière University Hospital, AP-HP University Paris Diderot, Paris, France; Cardiac Diseases and Biomarkers Unit, INSERM UMR-S 942, Department of Cardiology, Lariboisière University Hospital Paris, France.
authors.forename: Alain
authors.initials: A
authors.lastname: Cohen-Solal
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006439:Hemodynamics; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011379:Prognosis; D018570:Risk Assessment; D000072657:ST Elevation Myocardial Infarction / Q000175:diagnosis* / Q000401:mortality / Q000503:physiopathology; D013318:Stroke Volume / Q000502:physiology
keywords: Acute myocardial infarction; Heart failure; Hemodynamics; Natriuretic peptide; Prognosis