title: Ratio of systolic blood pressure to left ventricular end-diastolic pressure at the time of primary percutaneous coronary intervention predicts in-hospital mortality in patients with ST-elevation myocardial infarction.
abstract: OBJECTIVE
  To determine the ability of simple hemodynamic parameters obtained at the time of cardiac catheterization to predict in-hospital mortality following ST-elevation myocardial infarction (STEMI).
  
  
  BACKGROUND
  Hemodynamic parameters measured at the time of primary percutaneous coronary intervention (PPCI) could potentially identify high-risk patients who would benefit from aggressive hemodynamic support in the Cardiac Catheterization laboratory.
  
  
  METHODS
  This is a retrospective single-center study of 219 consecutive patients with STEMI. Left ventricular end-diastolic pressure (LVEDP), systolic blood pressure (SBP), and aortic diastolic blood pressure were obtained after successful revascularization. The prognostic ability of LVEDP, pulse pressure, and SBP/LVEDP ratio were compared to major mortality risk scores.
  
  
  RESULTS
  Patients had a mean age of 60 ±14 years, were predominantly white (73%), male (64%), with anterior wall infarcts in 39%. Comorbidities included diabetes mellitus (27%), heart failure (9%), and chronic kidney disease (7%). In-hospital mortality was 9%. Patients with SBP/LVEDP ≤ 4 had increased risk of in-hospital death (32% vs. 5.3%, P < 0.0001), intra-aortic balloon pump (IABP) usage (51.6% vs. 9.6%, P < 0.0001) and combined endpoint of death or IABP usage (58.1% vs. 13.3%, P < 0.0001) compared to patients with SBP/LVEDP > 4. The area under curve (AUC) for SBP/LVEDP ratio for in-hospital mortality (0.69) was more predictive than LVEDP (0.61, P = 0.04) or pulse pressure (0.55, P = 0.02) but similar to Shock Index (ratio of heart rate to SBP) and Modified Shock Index (ratio of HR to mean arterial pressure).
  
  
  CONCLUSIONS
  An SBP/LVEDP ratio ≤ 4 identified a group of STEMI patients at high risk of in-hospital death. © 2017 Wiley Periodicals, Inc.
authors.affiliation: University of North Carolina School of Medicine, University of North Carolina, Chapel Hill, NC.
authors.forename: Michael
authors.identifier: http://orcid.org/0000-0002-6943-7740
authors.initials: M
authors.lastname: Sola
authors.affiliation: Department of Medicine, Division of Cardiology, University of Massachusetts Medical School, Worcester, MA.
authors.forename: Kiran
authors.initials: K
authors.lastname: Venkatesh
authors.affiliation: Department of Medicine, Division of Cardiology and McAllister Heart Institute, University of North Carolina, Chapel Hill, NC.
authors.forename: Melissa
authors.initials: M
authors.lastname: Caughey
authors.affiliation: Department of Medicine, Division of Cardiology and McAllister Heart Institute, University of North Carolina, Chapel Hill, NC.
authors.forename: Robert
authors.initials: R
authors.lastname: Rayson
authors.affiliation: Department of Medicine, Division of Cardiology and McAllister Heart Institute, University of North Carolina, Chapel Hill, NC.
authors.forename: Xuming
authors.initials: X
authors.lastname: Dai
authors.affiliation: Department of Medicine, Division of Cardiology and McAllister Heart Institute, University of North Carolina, Chapel Hill, NC.
authors.forename: George A
authors.initials: GA
authors.lastname: Stouffer
authors.affiliation: Department of Medicine, Division of Cardiology and McAllister Heart Institute, University of North Carolina, Chapel Hill, NC.
authors.forename: Michael
authors.initials: M
authors.lastname: Yeung
mesh_terms: D000368:Aged; D019540:Area Under Curve; D001794:Blood Pressure; D006328:Cardiac Catheterization; D002316:Cardiotonic Agents / Q000627:therapeutic use; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007423:Intra-Aortic Balloon Pumping; D008297:Male; D008875:Middle Aged; D009657:North Carolina; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects / Q000401:mortality*; D011237:Predictive Value of Tests; D012372:ROC Curve; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D000072657:ST Elevation Myocardial Infarction / Q000175:diagnosis* / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D012770:Shock, Cardiogenic / Q000209:etiology / Q000401:mortality / Q000628:therapy; D013318:Stroke Volume; D013599:Systole; D013997:Time Factors; D016896:Treatment Outcome; D014662:Vasoconstrictor Agents / Q000627:therapeutic use; D016277:Ventricular Function, Left
chemical_list: D002316:Cardiotonic Agents; D014662:Vasoconstrictor Agents
keywords: LVEDP; ST-elevation myocardial infarction; cardiac catheterization; systolic blood pressure