Factors Associated with Elevated Left Ventricular End-Diastolic Pressure in Patients Undergoing Primary Percutaneous Coronary Intervention

Abstract

Objectives: The prognostic value of left ventricular end-diastolic pressure (LVEDP) in patients with ST-segment elevation myocardial infarction (STEMI) is well-established. However, data regarding clinical factors associated with elevated LVEDP remain limited. This study aimed to evaluate the clinical indicators and patient phenotype associated with elevated LVEDP among STEMI patients undergoing primary percutaneous coronary intervention (PCI), to aid individualized risk stratification. Methodology: This descriptive cross-sectional study enrolled patients diagnosed with STEMI who underwent primary PCI. LVEDP was measured using a fluid-filled pigtail catheter post-angiography but prior to reperfusion. Elevated LVEDP was defined as >25 mmHg. Results: A total of 498 patients were included, of which 23.7% (n=118) were female, with a mean age of 53.7 ± 11.7 years. LVEDP distribution was as follows: ≤15 mmHg in 48% (n=239), 15–25 mmHg in 42% (n=209), and >25 mmHg in 10% (n=50) of the patients. Elevated LVEDP was significantly associated with increased heart rate (adjusted odds ratio [aOR] 1.05 [1.02–1.08]), decreased systolic blood pressure (aOR 0.95 [0.90–0.99]), Killip class ≥II (aOR 9.36 [3.38–25.90]), and history of hypertension (aOR 4.63 [1.55–13.82]). Conclusion: Clinical indicators such as elevated heart rate, reduced systolic blood pressure, higher Killip class, and hypertension are significantly associated with elevated LVEDP in STEMI patients. Early identification of these factors may aid in hemodynamic risk assessment during primary PCI.