Korean J Med.  2022 Aug;97(4):257-270. 10.3904/kjm.2022.97.4.257.

The Impact of Pulmonary Hypertension on the Clinical Outcomes of Acute Myocardial Infarction after Percutaneous Coronary Intervention

• Cho EY
• Jeong MH
• Kim HY
• Park HJ
• Yoon HJ
• Kim KH
• Ahn YK

• KMID: 2532482
• DOI: http://doi.org/10.3904/kjm.2022.97.4.257

Abstract

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.

Keyword

폐동맥 고혈압; 심근경색증; 예후; Hypertension, pulmonary; Myocardial infarction; Mortality