Usefulness of Coronary Wedge Pressure for Predicting Long- Term Left Ventricular Remodeling after Primary PercutaneousCoronary Intervention in Anterior ST-Elevation Myocardial Infarction

초록

Background: The microvascular function after ST-elevation myocardial infarction (STEMI) was known to be an independent predictor of left ventricular functional improvement, and it is known that the coronary wedge pressure (Pcw) measured after primary percutaneous coronary intervention (PCI) was related with microvascular function in STEMI. We evaluated the usefulness of Pcw as a predictor of long-term left ventricular remodeling in anterior STEMI. Methods: Thirty patients with first anterior STEMI were enrolled. After primary PCI, the Pcw was measured using an intracoronary pressure wire (Radi Medical System, Uppsala, Sweden) during the balloon occlusion, and the proximal coronary pressure (Pa) was measured simultaneously at the tip of guiding catheter. The value of Pcw/Pa was calculated as the ratio of Pcw divided by Pa. We performed 18F-fluorodeoxyglucose positron emission tomography (FDG-PET) at 7 days after primary PCI. Echocardiography was performed at admission, and follow-up echocardiography was performed at 5.3 1.7 months. Results: The left ventricular end diastolic volume index (LVEDVI) and left ventricular end systolic volume index (LVESVI) at follow-up revealed significant correlations with Pcw (r 0.396, p 0.030) and Pcw/Pa (r0.398, p0.029). Using an receiver-operating characteristics curve analysis, best cutoff value (BCV) of Pcw and Pcw/Pa in predicting remodeling of LVESVI was 26 mm Hg (area under the curve [AUC]: 0.751, sensitivity: 92.3%, specificity: 52.9%) and 0.30 (AUC: 0.776, sensitivity: 84.6%, specificity: 70.6%), and Pcw and Pcw/Pa were comparable to the FDG-PET in accuracy for predicting LV remodeling (BCV: 40.2%, AUC: 0.778, sensitivity: 61.5%, specificity: 88.2%). Conclusion: Pcw and Pcw/Pa measured after primary PCI in patients with anterior STEMI were related to long-term LV volume changes and are useful to predict LV remodeling.