The Association of Left Ventricular End-Diastolic Pressure and Acute Left Ventricular End-Diastolic Pressure Change with Miyocardial Blush Grade and ST Segment Resolution in STEMI Patients Undergoing Primary Percutaneous Intervention

Abstract

Elevated left ventricular end-diastolic pressure (LVEDP) is associated with adverse outcomes among those patients with ST-elevation myocardial infarction (STEMI).We aim to investigate the acute change of LVEDP in patients with STEMI and the relationship between LVEDP and early reperfusion parameters, such as ST-segment resolution (STR%) and myocardial blush grade (MBG).A total of 51 consecutive patients with STEMI who had undergone successful primary percutaneous coronary intervention (pPCI) with TIMI flow grade 3 were included in the study. LVEDP measurements were performed at the beginning (pre-pPCI LVEDP) and end of (post-pPCI LVEDP) the pPCI. MBG was defined after a successful pPCI; STR% was calculated 60 minutes after pPCI.The mean pre-pPCI LVEDP was 22.1 ± 4.8 mmHg and the post-pPCI LVEDP was 19.4 ± 4.8 mmHg. There was a mean 2.7±1.8 mmHg decrease in LVEDP values after pPCI which was statistically significant (95% CI -3.2, -2.2, p value< 0.001). Post-pPCI LVEDP median value was 19 mmHg. The patients were divided into two groups according to median value: there were 26 (51%) patients with post-pPCI LVEDP? 19 mmHg and 25 (49%) patients with post-pPCI LVEDP> 19 mmHg. STR% and MBG were significantly different between the two groups (p= 0.03 and p= 0.01). Post-pPCI LVEDP had a moderate negative correlation with MBG (r= -0.438) and STR% (r= -0.501).In this study, we demonstrated that primary PCI might substantially reduce the LVEDP level. Moreover, the LVEDP levels achieved after PCI might be associated with myocardial reperfusion, assessed by STR% on ECG and MBG during angiography.