The use of hemodynamics to predict mortality in patients undergoing primary PCI for ST-elevation myocardial infarction

Abstract

Challenges remain in predicting mortality and severe myocardial dysfunction in patients undergoing primary percutaneous coronary intervention (PPCI) for ST elevation myocardial infarction (STEMI). Areas covered: Cardiogenic shock is associated with a high mortality rate. Less well characterized are patients who are not in cardiogenic shock but will die from pump failure as a result of a STEMI. There is a long history of using hemodynamics to risk stratify patients with acute MI with the Killip class being shown to provide prognostic information in the prereperfusion, thrombolytic and PPCI eras. Recent studies have identified low systolic blood pressure (SBP), elevated heart rate, elevated left ventricular end diastolic pressure (LVEDP), and low SBP/LVEDP ratio as hemodynamic parameters associated with early mortality in patients undergoing PPCI. Although infrequently used, prognostic information can be obtained from right heart catheterization in the setting of STEMI with the best-studied parameters being cardiac power, pulmonary capillary wedge pressure (PCWP), cardiac output, right atrial pressure/PCWP ratio, and pulmonary artery pulsatility index. Expert commentary: Hemodynamic parameters measured at the time of PPCI provide important prognostic information. Whether hemodynamics can be used to determine which patients benefit from early initiation of mechanical support remains to be determined.

Risk assessment for mortality in patients with ST‐elevation myocardial infarction undergoing primary percutaneous coronary intervention: A retrospective cohort study

“… 32 Recent studies have suggested a high rate of mortality and rapid deterioration among STEMI patients who present with cardiogenic shock. 33 In this study, 3.7% of patients presented with shock upon admission. However, the lack of data on pulmonary capillary wedge pressure and cardiac index prevented us from definitively diagnosing cardiogenic shock.…”

“…Moreover, in a sub‐study of the Assessment of Pexelizumab in Acute Myocardial Infarction (APEX‐AMI) trial, it was shown that SBP (HR 0.86/10 mmHg increments, 95% CI: 0.82–0.90), heart rate (HR 1.45/10 beat increments, 95% CI: 1.31–1.59) and Killip class of ≥3 (HR 4.24, 95% CI: 2.97–6.08) are significant predictors of 90‐day mortality in patients with STEMI who undergo primary PCI within 6 h of pain onset 32 . Recent studies have suggested a high rate of mortality and rapid deterioration among STEMI patients who present with cardiogenic shock 33 . In this study, 3.7% of patients presented with shock upon admission.…”

Evaluation of shock index and modified shock index in estimation of MACE parameters in patients with ST elevated myocardial infarction

“…In a study conducted with 159 patients with acute pulmonary embolism, evaluating the success of SI and echocardiography findings in predicting in-hospital complications and mortality, a SI score of 1 or higher was found to be associated with increased mortality 3 . In a study by Goins et al, MSI and SI were reported to be a significant predictor for 30-day in-hospital mortality 15 . Singh et al reported that MSI and SI were a good predictor of mortality, but MSI was found to be more valuable than SI 16 .…”

Evaluation of the right atrial phasic functions in patients with anterior ST-elevation myocardial infarction: a 2D speckle-tracking echocardiography study

“…In patients with ASTEMI, the stroke volume is acutely reduced, which may lead to lower return flow to the RA [ 31 , 32 ]. The lower return of blood in each cardiac cycle to the RA results in less available blood for storage during the reservoir phase and less stretching of RA myocardium.…”