Association between Echocardiography Assessed Right Atrial Pressure, Left Ventricular Function and Mortality in ST Segment Elevation Myocardial Infarction Patients

Background: The prognostic implications of increased right atrial pressure (RAP) in ST segment elevation (STEMI) patients has not been reported previously. We aimed to evaluate the possible relation of elevated CVP, assessed by echocardiography, and long term survival a large population of STEMI patients undergoing reperfusion with primary percutaneous coronary intervention (PCI)

Methods: We conducted a retrospective study of 1344 STEMI patients undergoing primary PCI between June 2012 and June 2018. Comprehensive echocardiographic examination was performed within 72 hours of hospital admission, which included non-invasive evaluation of RAP from measurements of diameter and collapsibility of the inferior vena cava into normal (5 mm/hg) intermediate (10-15 mm/hg) and high (20 mm/hg) RAP. Patients were stratified according to RAP and assessed for short and long term mortality.

Results: Higher RAP was associated with both significantly higher 30 –day

1.4% vs.4.5% vs. 14.6%; p<0.001) and long term mortality ( 7% vs. 21% vs. 36 %;p<0.001). The negative effect of RAP > 10 mm/hg on long term mortality was maintained in subgroups of patients with ejection fraction > 45 ( 6% vs. 15%;p<0.001) and < 45 % (9% vs. 27%;p<0.001) ,stroke volume index > 35 ml/m² ( 9% vs. 27% ;p<0.001) and stroke volume index ≤ 35 ml/m² ( 7% vs. 32% ;p<0.001)

Conclusions: Among STEMI patients undergoing PCI, elevated RAP is associated with adverse short and long term mortality