Association of Systolic BP to LVED Pressure Ratio with In-Hospital Mortality in STEMI Patients Undergoing PPCI

Authors

  • Zeeshan Arif Department of Adult Cardiology, Armed Forces Institute of Cardiology & National Institute of Heart Diseases/National University of Medical Sciences (NUMS), Rawalpindi, Pakistan
  • Syed Khurram Shahzad Department of Adult Cardiology, Armed Forces Institute of Cardiology & National Institute of Heart Diseases/National University of Medical Sciences (NUMS), Rawalpindi, Pakistan
  • Zahoor Aslam Khan Department of Adult Cardiology, Armed Forces Institute of Cardiology & National Institute of Heart Diseases/National University of Medical Sciences (NUMS), Rawalpindi, Pakistan
  • Iftikhar Ahmed Department of Adult Cardiology, Armed Forces Institute of Cardiology & National Institute of Heart Diseases/National University of Medical Sciences (NUMS), Rawalpindi, Pakistan
  • Masood Khan Department of Adult Cardiology, Armed Forces Institute of Cardiology & National Institute of Heart Diseases/National University of Medical Sciences (NUMS), Rawalpindi, Pakistan
  • Faiza Alam Department of Adult Cardiology, Armed Forces Institute of Cardiology & National Institute of Heart Diseases/National University of Medical Sciences (NUMS), Rawalpindi, Pakistan
  • Abdul Hameed Siddiqui Department of Adult Cardiology, Armed Forces Institute of Cardiology & National Institute of Heart Diseases/National University of Medical Sciences (NUMS), Rawalpindi, Pakistan

DOI:

https://doi.org/10.51253/pafmj.v74iSUPPL-1.10896

Keywords:

In-hospital mortality, Left Ventricular End-Diastolic Pressure, Primary Percutaneous Coronary Intervention, Systolic blood pressure

Abstract

Objective: To determine the association of Systolic Blood Pressure to Left Ventricular End-Diastolic Pressure ratio with in-hospital mortality in ST-Elevation Myocardial Infarction patients undergoing Primary Percutaneous Coronary Intervention.

Study Design: Analytical, Cross-sectional study.

Place and Duration of Study: Armed Forces Institute of Cardiology, National Institute of Heart Diseases, Rawalpindi Pakistan, from Apr-Jun 2023.

Methodology: One hundred and ninety-eight patients who underwent Primary Percutaneous Coronary Intervention for ST-Elevation Myocardial Infarction patients presenting within 12-hours were included using non-probability consecutive sampling technique. Patients were divided into two groups (Group-I= SBP/LVEDP ratio ≤4; Group-II= SBP/LVEDP ratio >4). SBP and LVEDP were measured during Primary Percutaneous Coronary Intervention. Demographic and clinical data, including risk factors and laboratory findings, were collected and SBP/LVEDP ratio was calculated. Study variables were compared among groups by applying independent t-test and Chi-square test. p-value<0.05 was kept as significant.

Results: Among the study sample of 198, 126(63.6%) were males and females were 72(36.3%), mean age was 61.31±9.16 years. 21(10.6%) patients had SBP/LVEDP ratio≤4 (Group-I), while 177(89.3%) patients had SBP/LVEDP ratio>4 (Group-II). Group-I showed a higher prevalence of heart failure 5(23.8%), lower ejection fraction (35.48±7.56%), longer duration of in-hospital stay (8.76±2.48 days) (p<0.05), and higher TIMI scores (9.28±1.10) compared to Group-II. In-hospital mortality was also higher in Group-I (33.3%), compared to Group-II (6.2%) (p<0.05).

Conclusion: The SBP/LVEDP ratio≤4 has significantly predicted increased risk of adverse outcomes and in-hospital mortality in STEMI patients who underwent Primary Percutaneous Coronary Intervention. This ratio may serve as a marker of compromised c....

Downloads

Download data is not yet available.

References

Siddiqui TI, Kumar KSA, Dikshit DK. Platelets and atherothrombosis: causes, targets and treatments for thrombosis. Curr Med Chem 2013; 20(22): 2779–97.

https://doi.org/10.2174/0929867311320220004

Gaziano TA, Bitton A, Anand S, Abrahams-Gessel S, Murphy A. Growing epidemic of coronary heart disease in low- and middle-income countries. Curr Probl Cardiol 2010; 35(2): 72–115.

https://doi.org/10.1016/j.cpcardiol.2009.10.002

Kearney P, Whelton M, Reynolds K, Muntner P, Whelton P, He J. et al. Global burden of hypertension: analysis of worldwide data. Lancet 2005; 365(9455): 217–23.

https://doi.org/10.1016/S0140-6736(05)17741-1

Joshi P, Islam S, Pais P, Reddy S, Dorairaj P, Kazmi K, et al. Risk factors for early myocardial infarction in South Asians compared with individuals in other countries. JAMA 2007; 297(3): 286–94.

https://doi.org/doi: 10.1001/jama.297.3.286

Rizvi SF, Khan MA, Kundi A, Marsh DR, Samad A, Pasha O. et al. Status of rheumatic heart disease in rural Pakistan. Heart 2004; 90(4): 394–9. https://doi.org/10.1136/hrt.2003.025981

Liaquat A, Javed Q. Current trends of cardiovascular risk determinants in Pakistan. Cureus [Internet] 2018.

https://doi.org/10.7759/cureus.3409

Kannel W. Risk stratification in hypertension: new insights from the Framingham study*1. Am J Hypertension 2000; 13(1): S3–S10.

https://doi.org/10.1016/s0895-7061(99)00252-6

Malik J, Laique T, Farooq MH, Khan U, Malik F, Zahid M, Majid A. et al. Impact of Primary Percutaneous Coronary Intervention on Complete Atrioventricular Block With Acute Inferior ST-Elevation Myocardial Infarction. Cureus 2020 Aug 25; 12(8): e10013. https://doi.org/10.7759/cureus.10013

Planer D, Mehran R, Witzenbichler B, Guagliumi G, Peruga JZ, Brodie, B.R, et al. Prognostic utility of left ventricular end-diastolic pressure in patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention. Am J Cardiol 2011; 108: 1068–1074.

https://doi.org/10.1016/j.amjcard.2011.06.007

El-Menyar A, Zubaid M, Almahmeed W, Alanbaei M, Rashed W, Al Qahtani A, et al. Initial hospital pulse pressure and cardiovascular outcomes in acute coronary syndrome. Arch Cardiovasc Dis 2011; 104: 435–443. https://doi.org/10.1016/j.acvd.2011.05.008

Hashmi KA, Adnan F, Ahmed O, Yaqeen SR, Ali J, Irfan M, et al. Risk Assessment of Patients After ST-Segment Elevation Myocardial Infarction by Killip Classification: An Institutional Experience. Cureus | Risk Assessment of Patients After ST-Segment Elevation Myocardial Infarction by Killip Classification: An Institutional Experience 2020.

https://doi.org/10.7759/cureus.12209

Halder KC, Hashem MA, Showkat T, Rahman SO, Islam MMKJSJAMS. Acute Coronary Syndrome among Patients with Chest Pain: Prevalence and Common Cardiovascular Risk Factors 2022; 8: 1181-4. https://doi.org/10.36347/sjams.2022.v10i08.003

Gov.in. [cited 2023 May 19]. https://dghs.gov.in/WriteReadData/userfiles/file/NPCDCS/Fin%20-%20STEMI%20Guidline.pdf

Sola M, Venkatesh K, Caughey M, Rayson R, Dai X, Stouffer GA, et al. 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: SBP/LVEDP ratio in STEMI. Catheter Cardiovasc Interv 2017; 90(3): 389–95.

https://doi.org/10.1002/ccd.26963

Tao F, Wang W, Yang H, Han X, Wang X, Dai Y, Zhu A, Han Y, Guo P. et al. Characteristics, Prognosis, and Prediction Model of Heart Failure Patients in Intensive Care Units Based on Preserved, Mildly Reduced, and Reduced Ejection Fraction. Reviews in Cardiovascular Medicine 2023 Jun 6; 24(6): 165.

Liu C, Caughey MC, Smith SC Jr, Dai X. Elevated left ventricular end diastolic pressure is associated with increased risk of contrast-induced acute kidney injury in patients undergoing percutaneous coronary intervention. Int J Cardiol 2020; 306: 196–202. https://doi.org/10.1016/j.ijcard.2020.01.064

Banga S, Gumm DC, Kizhakekuttu TJ, Emani VK, Singh S, Singh S, et al. Left ventricular ejection fraction along with Zwolle risk score for risk stratification to enhance safe and early discharge in STEMI patients undergoing primary percutaneous coronary intervention: A retrospective observational study. Cureus 2019; 11(7): e5272. https://doi.org/10.7759/cureus.5272

Cubeddu RJ, Don CW, Horvath SA, Gupta PP, Cruz-Gonzalez I, Witzke C, et al. Left ventricular end-diastolic pressure as an independent predictor of outcome during balloon aortic valvuloplasty: LVEDP as a Predictor of Outcome During BAV. Catheter Cardiovasc Interv 2014 [cited 2023 May 20]; 83(5): 782–8.

https://doi.org/10.1002/ccd.24410

Millo L, McKenzie A, De la Paz A, Zhou C, Yeung M, Stouffer GA. et al. Usefulness of a novel risk score to predict in-hospital mortality in patients ≥60 years of age with ST elevation myocardial infarction. The American Journal of Cardiology 2021 Sep 1; 154: 1-6.

Venkatesh K, Yeung M, Stouffer G. The ratio of systolic blood pressure to left ventricular end diastolic pressure predicts survival in patients presenting with acute myocardial infarction. J Am Coll Cardiol 2015; 65(10): A198.

https://doi.org/10.1016/s0735-1097(15)60198-x

Ebaid HH, El-Rabbat KE, Attia WA, Allam HI. Role of Systolic Blood Pressure to Left Ventricular End-Diastolic Pressure Ratio in Prediction of Major Adverse Cardiovascular Events in Patients with ST-segment Elevation Myocardial Infarction Treated by Primary Percutaneous Coronary Intervention. Egyptian Journal of Hospital Medicine 2023 Jul 1; 92(1).

Downloads

Published

30-05-2024

Issue

Section

Original Articles

How to Cite

1.
Arif Z, Shahzad SK, Aslam Khan Z, Ahmed I, Khan M, Alam F, et al. Association of Systolic BP to LVED Pressure Ratio with In-Hospital Mortality in STEMI Patients Undergoing PPCI. Pak Armed Forces Med J [Internet]. 2024 May 30 [cited 2024 Jun. 16];74(SUPPL-1):S17-S21. Available from: https://pafmj.org/PAFMJ/article/view/10896