Abstract 13022: Hemodynamic Parameters of Pulmonary Circulation in Acute Coronary Syndrome: Incremental Prognositic Value for Long-term Survival

Abstract

Objectives: To identify right heart catheterization (RHC)-assessed hemodynamic parameters of pulmonary circulation that were prognostic predictive of long-term survival in acute coronary syndrome (ACS), and to explore the incremental value of those parameters to the established risk models of coronary heart disease. Methods: Consecutive patients with ACS who underwent coronary angiography together with RHC were retrospectively reviewed. The primary endpoint was all-cause mortality. To identify the association between hemodynamic parameters and survival, Cox proportional hazards models were conducted. The optimal parameter identified was included in three subsequent models, which contained the Global Registry of Acute Coronary Events (GRACE), the Long-Term Intervention with Pravastatin in Ischemic Disease (LIPID) and the Cardiovascular Disease Research Using Linked Bespoke Studies and Electronic Health Records (CALIBER) models respectively. Model performance was evaluated before and after the addition of hemodynamic parameters. Results: A total of 251 patients were enrolled, with a median follow-up time of 34.7 months. By Cox analyses, systolic pulmonary arterial pressure [hazard ratio (HR): 1.043, 95% confidence interval (CI): 1.013-1.074], diastolic pulmonary arterial pressure (HR: 1.086, 95% CI: 1.014-1.164), mean pulmonary arterial pressure (HR: 1.077, 95% CI: 1.024-1.132), right ventricular systolic pressure (HR: 1.039, 95% CI: 1.008-1.070) and diastolic pressure gradient (HR: 1.101, 95% CI: 1.015-1.193) were found to be independent predictors of long-term survival. Furthermore, the addition of mean pulmonary arterial pressure to the established risk models yielded an improvement in model performance (integrated discriminatory index for the GRACE, LIPID and CALIBER model: 4.3%, 4.4% and 4.7%, respectively; all had a P<0.05). Conclusions: Hemodynamic parameters of pulmonary circulation can be predictive of long-term survival and provide incremental prognostic value to risk assessment in patients with ACS.