Hemodynamic changes acutely determined by primary PCI in STEMI patients evaluated with a minimally invasive method

Objective: Few studies are available on the hemodynamic changes acutely determined by Primary Percutaneous Coronary Intervention (PCI) in ST-Elevation Myocardial Infarction (STEMI) patients, probably for the difficult evaluation of hemodynamic variables in this acute setting. Therefore, the paper is to evaluate the variations of several hemodynamic parameters determined by PCI using PRAM (Pressure Recording Analytical Method), minimally invasive hemodynamic monitoring. Methods: We analyzed in 20 STEMI patients submitted to PCI several hemodynamic variables, assessed with PRAM from radial/ femoral artery, 3-minute before PCI and at endprocedure. Variables measures were: systolic, diastolic, dicrotic and mean arterial pressures; heart rate (HR); stroke volume (SV); systemic vascular resistance (SVR); dP/dtmax; cardiac cycle efficiency (CCE). Results: In our patients HR, SVR and dP/dtmax decreased significantly (85 ± 6.3 to 77 ± 4.5, p = 0.002; 1738 ± 241 to 1450 ± 253, p = 0.022; 1.22 ± 0.11 to 1.11 ± 0.12, p = 0.007, respectively) while CCE and SV increased significantly (−0.25 ± 0.23 to −0.01 ± 0.12, p < 0.001; 53 ± 8.4 to 65 ± 11.2, p < 0.001, respectively). Conclusions: Hemodynamic monitoring with PRAM seems feasible during primary PCI and can provide further notions regarding the acute effects determined on cardiovascular system by the culprit artery revascularization. The most significant hemodynamic changes acutely observed in our study should be mainly ascribed to the reduction in sympathetic activity after PCI with a rapid improvement of the cardiovascular system efficiency.