Predictive accuracy of systolic blood pressure to left ventricular end-diastolic pressure ratio versus TIMI score for short-term mortality after primary percutaneous coronary intervention

TL;DR

This study compares the SBP/LVEDP ratio and TIMI score for predicting mortality in STEMI patients after primary PCI, finding both to be similarly effective.

Contribution

The study demonstrates that the SBP/LVEDP ratio is a rapid and effective alternative to the TIMI score for predicting mortality in STEMI patients.

Findings

Patients with SBP/LVEDP ≤5.4 had significantly higher in-hospital and short-term mortality rates.

The AUCs for SBP/LVEDP and TIMI were comparable for predicting both in-hospital and short-term mortality.

SBP/LVEDP is a readily available and practical tool for rapid prognostic assessment during primary PCI.

Abstract

Aim of this study was to evaluate the predictive performance of systolic blood pressure (SBP) to left ventricular end-diastolic pressure (LVEDP) ratio for the prediction of in-hospital and short-term mortality in a contemporary cohort of patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI) at a tertiary care cardiac center.

This study included a consecutive series of patients diagnosed with STEMI who underwent primary PCI. The SBP/LVEDP ratio and TIMI (Thrombolysis in Myocardial Infarction) score were calculated, and their ability to predict in-hospital and short-term mortality was evaluated by analyzing the area under the curve (AUC) on the receiver operating characteristics (ROC) curve.

This study involved 977 patients, with 780 (79.8%) being male and a mean age of 55.6±11.5 years. Among them, 191 (19.5%) had an SBP/LVEDP≤5.4. The in-hospital mortality rate was 4.3% (42), and the short-term all-cause mortality rate after a mean follow-up of 5.9±2.4 months was 15% (140). Patients with SBP/LVEDP≤5.4 had higher in-hospital mortality rates (14.1% vs. 1.9%; P<0.001) and short-term mortality rates (35.1% vs. 9.8%; P<0.001) compared to those with SBP/LVEDP>5.4. The AUCs of SBP/LVEDP and TIMI for predicting in-hospital mortality were 0.766 [0.681-0.851] and 0.787 [0.713-0.861], respectively. For short-term mortality, the AUCs of SBP/LVEDP and TIMI were 0.731 [0.682-0.780] and 0.736 [0.690-0.782], respectively.

In conclusion, SBP/LVEDP showed sufficiently high predictive power comparable to the TIMI risk score. SBP/LVEDP is a readily available ratio that can rapidly provide valuable prognostic information during primary PCI.

Figures