Impact of Postprocedural Left Ventricular End-Diastolic Pressure on Microvascular Perfusion and Myocardial Function after Primary Percutaneous Coronary Intervention in Acute Myocardial Infarction

Abstract

Objectives: To determine the impact of left ventricular end-diastolic pressure (LVEDP) on microvascular reperfusion indices and ventricular function following primary percutaneous coronary intervention (PCI) in patients with acute ST-elevation myocardial infarction (STEMI). Methodology: This prospective cohort study included 250 consecutive STEMI patients who underwent primary PCI with successful restoration of TIMI-3 epicardial flow. Postprocedural LVEDP was measured and patients were categorized into two groups: high LVEDP (>19 mmHg) and low LVEDP (≤19 mmHg). Study outcomes included TIMI myocardial perfusion (TMP) grade, ST-segment resolution (>50%), and left ventricular ejection fraction (LVEF) at one-month follow-up. Multivariable logistic regression was used to evaluate associations while adjusting for age, sex, infarct location, and time to PCI. Results: The mean age was 54.8 ± 11.8 years, and 83% were male. Elevated LVEDP independently predicted poorer TMP grade (aOR 1.22; 95% CI 1.13–1.32; p < 0.001), incomplete ST-segment resolution (aOR 1.11; 95% CI 1.05–1.18; p = 0.001), and reduced LVEF (<40%) (aOR 1.21; 95% CI 1.11–1.32; p < 0.001). Older age and anterior wall infarction were additional predictors of reduced systolic recovery. Conclusion: Elevated LVEDP independently predicts impaired myocardial reperfusion, incomplete electrical recovery, and reduced left ventricular systolic function after primary PCI in STEMI patients. Routine intra-procedural LVEDP measurement may help identify patients at risk for microvascular dysfunction and guide targeted post-PCI management.