Reply to the Letter to the Editor Entitled “Prognostic Value of Elevated Pulmonary Artery Systolic Pressure on Short Term in Patients With Acute Myocardial Infarction”

Abstract

We appreciate the comments of Pamukcu and Acikel 1 about our paper entitled "Effect of Elevated Pulmonary Artery Systolic Pressure on Short-Term Prognosis in Patients with Acute Myocardial Infarction." 2 We would like to state that this was a retrospective study, which mainly reflected the independent effect of pulmonary artery systolic pressure (PASP) on shortterm death, without further subgroup analysis, such as the analysis of association between PASP and acute myocardial infarction (AMI) site, revascularization time, or diuretics. "PASP was associated with AMI site" was reported by Mutlak et al 3 , and one guideline 4 also pointed out that pulmonary hypertension can occur due to acquired left ventricular disease. The investigation of the association between PASP and AMI site will be the subject of our further study. The association between prognosis, AMI size, and systolic function of the left ventricle is known. 5 However, not all patients with elevated PASP had a ST-segment elevation myocardial infarction (STEMI), non-STEMI (NSTEMI) patients accounted for a larger part of our study. So we focused on the clinical characteristics and short-term mortality of patients with elevated PASP, rather than AMI region and type. Pamukcu and Acikel 1 in their letter to the Editor comment on the "lower PCI rate in the high PASP group." We agree that the mortality is expected to be lower after successful revascularization. 6 There were 69.5% of patients with Killip classification II to IV in the high PASP group, and it was very difficult to implement percutaneous coronary intervention successfully in these critically ill patients. 7,8 We can also say that PASP increased because these patients failed to be revascularized successfully, and eventually the mortality rate increased. More detailed analysis and evaluation of PASP are essential in future research. We also look forward to better documenting the association between PASP and prognosis. ORCID iD Xiao-ting Fan