학술대회 발표 연제 초록

Background: The microvascular function after ST elevation myocardial infarction (STEMI) was known to be an independent predictor of left ventricular functional improvement. We evaluated the usefulness of the coronary wedge pressure (Pcw), which is known to be related with microvascular function, measured after primary coronary intervention (PCI) 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 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 seven days after PCI. Echocardiography was performed at admission and follow-up echocardiography was performed at 5.3짹1.7 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 (r=0.398, p=0.029). Using an receiver-operating characteristics curve analysis, best cutoff value (BCV) of Pcw and Pcw/Pa in predicting remodeling of LVESVI was 26 mmHg [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 with long-term LV volume changes and useful in predicting LV remodeling.