title: Prognostic Value of Left Ventricular End-Diastolic Pressure in Patients With Non-ST-Segment Elevation Myocardial Infarction.
abstract: BACKGROUND
  Elevated left ventricular end-diastolic pressure (LVEDP) has been reported to predict an increased mortality in patients with ST-segment elevation myocardial infarction. However, its prognostic value in patients with non-ST-segment elevation myocardial infarction (NSTEMI) remains unclear.
  
  
  METHODS
  We performed a retrospective analysis of NSTEMI patients who underwent coronary angiography between January 2013 and June 2014. We excluded patients who did not undergo LVEDP measurements. Baseline and angiographic characteristics, in-hospital heart failure as well as in-hospital mortality were recorded.
  
  
  RESULTS
  After exclusion, 367 patients were included in the final analysis. The median (interquartile range) LVEDP was 19 mm Hg (14 - 24 mm Hg). By receiver operating characteristic curve analysis, the optimal cutoff value for predicting in-hospital mortality was 22 mm Hg (area under the curve 0.80, sensitivity 80%, and specificity 71%). Of 367 patients, 109 patients (29.7%) had LVEDP > 22 mm Hg. Patients with LVEDP > 22 mm Hg had a greater number of comorbidities. There was no statistically significant difference in the rate of multi-vessel disease. Patients with LVEDP > 22 mm Hg had a significantly higher rate of in-hospital heart failure (22.0% vs. 13.2%, P = 0.03) and in-hospital mortality (3.7% vs. 0.4%, P = 0.03) than those with LVEDP ≤ 22 mm Hg.
  
  
  CONCLUSIONS
  Elevated LVEDP was significantly associated with a higher in-hospital mortality in patients with NSTEMI.
authors.affiliation: Department of Internal Medicine, Mount Sinai Beth Israel, New York, USA.
authors.forename: Akihiro
authors.initials: A
authors.lastname: Kobayashi
authors.affiliation: Department of Internal Medicine, Mount Sinai Beth Israel, New York, USA.
authors.forename: Naoki
authors.initials: N
authors.lastname: Misumida
authors.affiliation: Department of Cardiology, Mount Sinai Beth Israel, New York, USA.
authors.forename: John T
authors.initials: JT
authors.lastname: Fox
authors.affiliation: Department of Cardiology, Mount Sinai Beth Israel, New York, USA.
authors.forename: Yumiko
authors.initials: Y
authors.lastname: Kanei
keywords: Acute coronary syndrome; Heart failure; Left ventricular end-diastolic pressure; Mortality; Non-ST-segment elevation myocardial infarction