To achieve these aims, we utilized data from the Thrombolysis in Myocardial Infarction (TIMI) II ( Identifier: NCT00000505) study. The aims of the current analysis were to: (1) define the change in LVEDP over time after reperfusion of the infarct artery, and (2) assess the prognostic value of the elevated LVEDP in STEMI patients. However, no studies have evaluated the natural history of LVEDP after reperfusion of the infarct artery, and few studies have assessed its usefulness in predicting outcomes in patients with STEMI those that have, have shown it to be a predictor of death and heart failure. Left ventricular end-diastolic pressure (LVEDP), which reflects global left ventricular compliance, is easily measured during cardiac catheterization. Although the prognostic utility of reduced left ventricular ejection fraction (LVEF) along with patients’ age, infarct size and location, ventricular arrhythmias, ischemic mitral regurgitation, and cardiogenic shock are well established, the prognostic implications of diastolic indices in STEMI have rarely been explored, despite diastolic dysfunction either preceding or occurring independent of systolic dysfunction. ST-segment elevation myocardial infarction (STEMI) affects both left ventricular systolic and diastolic function. Elevated LVEDP is a predictor of death and heart failure hospitalization in STEMI patients undergoing successful thrombolysis. LVEDP remains largely stable during hospitalisation post-STEMI. 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. 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. Patients were divided into quartiles by LVEDP measured during the first cardiac catheterization. The median LVEDP for the whole cohort was 18 mmHg (IQR: 12–23). 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. 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. Definite ST occurred more in patients with poor, versus good, initial TIMI flow, mainly driven by difference in early events.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.Ī 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. Predictors of poor initial TIMI flow included presentation by ST-elevation myocardial infarction, and target vessel other than left anterior descending artery. This was driven by more frequent early events (30 days) ( p = .036) late/very late events were comparable ( p = 1.0). Definite ST was more frequent in patients with initial TIMI 0/1 flow (3.6% versus 1.5%, respectively, p = .048). Individual endpoints were comparable ( p > .05 for all). MACE rate was comparable between the 2 subgroups (14% versus 15.9%, in patients with poor versus good initial TIMI flow, respectively, p = .46). Presentation by ST-elevation myocardial infarction and target vessel other than left anterior descending artery predicted initial TIMI 0/1 flow. Of 827 patients enrolled, 279 (33.7%) had initial TIMI 0/1 flow. Propensity score-matched analysis was performed. Stent thrombosis (ST) was adjudicated according to the criteria of definite ST described by the Academic Research Consortium. The primary endpoint was major adverse cardiac events (MACE): a composite of cardiac death, non-fatal myocardial infarction or ischemia-driven target lesion revascularization. Poor initial TIMI flow was defined as baseline TIMI flow grade 0/1 at the initial coronary angiography. We performed post-hoc analysis of a randomized trial of patients presenting with ACS who received 2 comparative stents. We explored the predictors and outcome of poor, versus good, initial TIMI flow in patients with acute coronary syndrome (ACS).
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