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KMID : 0882420220970040257
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Korean Journal of Medicine
2022 Volume.97 No. 4 p.257 ~ p.270
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The Impact of Pulmonary Hypertension on the Clinical Outcomes of Acute Myocardial Infarction after Percutaneous Coronary Intervention
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Cho Eun-Young
Jeong Myung-Ho
Kim Hyung-Yoon
Park Hyuk-Jin
Yoon Hyun-Ju
Kim Kye-Hun
Ahn Young-Keun
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Abstract
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Background/Aims: Pulmonary hypertension (PH) in patients with heart failure contributes to a poor prognosis. However, the role of PH in the long-term clinical outcome is unclear in those with acute myocardial infarction (AMI). The clinical significance of elevated right ventricular systolic pressure (RVSP) on routine echocardiography is underestimated.
Methods: This study enrolled 2,526 AMI patients (65.1 ± 12.7 years; 1,757 males [69.6%]) from the Korean AMI registry who underwent successful percutaneous coronary intervention and pre-discharge transthoracic echocardiography (TTE). The patients were divided into four groups according to the RVSP on TTE: normal RVSP (RVSP < 35 mmHg, n = 1,695), mild PH (35 ≤ RVSP < 45 mmHg, n = 601), moderate PH (45 ≤ RVSP < 70 mmHg, n = 211), and severe PH (RVSP ≥ 70 mmHg, n = 19). Major adverse cardiac events (MACE) were compared among the four groups.
Results: During the 3-year clinical follow-up period, MACE occurred in 562 patients (22.2%), including 321 (18.9%), 145 (24.1%), 83 (39.3%), and 13 patients (68.4%) in the normal RVSP and mild, moderate, and severe PH groups, respectively. On multivariate analysis, independent factors for MACE were moderate or severe PH, age ≥ 65 years, Killip class ≥ III, left ventricular ejection fraction < 40%, hypertension, and diabetes.
Conclusions: Measuring RVSP is useful for stratifying the risk of patients with AMI; MACE occurred in patients with moderate or severe PH.
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KEYWORD
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Hypertension, pulmonary, Myocardial infarction, Mortality
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