The Importance of Intra-aortic Pulse Pressure After Anterior ST-segment Elevation Myocardial Infarction (original) (raw)
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Therapeutics and Clinical Risk Management
Background: The purpose of this retrospective study was to evaluate the prognostic impact of systolic blood pressure (SBP) and heart rate (HR) on in-hospital mortality in ST-segment elevation acute myocardial infarction (STEMI) patients, after primary percutaneous intervention (PCI). Patients and methods: The study included 294 patients admitted for STEMI. They were divided into five groups according to the SBP at admission: group I, ,105 mmHg; group II, 105-125 mmHg; group III, 126-140 mmHg; group IV, 141-158 mmHg; and group V, 159mmHg.IncreasedHRwasdefinedas159 mmHg. Increased HR was defined as 159mmHg.IncreasedHRwasdefinedas80 beats per minute (bpm). In-hospital death was defined as all-cause death during admission and classified into cardiac and noncardiac death. Results: Among the 294 patients admitted for STEMI, 218 (74%) were men. The mean age was 62±17 years. In-hospital mortality rate was 6% (n=18), with 11 (3.7%) deaths having cardiac causes. The highest mortality was registered in group I (n=9, 16%, P=0.018). Compared to the other groups, group I patients were older (P=0.033), more often smokers (P=0.026), and had a history of myocardial infarction (P=0.003), systemic hypertension (P=0.023), diabetes (P=0.041), or chronic kidney disease (P=0.0200). They more often had a HR 80bpm(P=0.028)andaKillipclass3or4atadmission(P=0.020).Thepeakcreatinephosphokinase−MBlevelwassignificantlyhigherinthisgroup(P=0.005),whiletheangiographicfindingsmoreoftenidentifiedasculpritlesionsweretherightcoronaryartery(P=0.005),theleftmaintrunk(P=0.040),oramultivesselcoronaryarterydisease(P=0.044).MultivariateanalysisshowedthatgroupIpatientshadasignificantlyhigherriskforbothall−causedeath(P=0.006)andcardiacdeath(P=0.003).PatientswithHR80 bpm (P=0.028) and a Killip class 3 or 4 at admission (P=0.020). The peak creatine phosphokinase-MB level was significantly higher in this group (P=0.005), while the angiographic findings more often identified as culprit lesions were the right coronary artery (P=0.005), the left main trunk (P=0.040), or a multivessel coronary artery disease (P=0.044). Multivariate analysis showed that group I patients had a significantly higher risk for both all-cause death (P=0.006) and cardiac death (P=0.003). Patients with HR 80bpm(P=0.028)andaKillipclass3or4atadmission(P=0.020).Thepeakcreatinephosphokinase−MBlevelwassignificantlyhigherinthisgroup(P=0.005),whiletheangiographicfindingsmoreoftenidentifiedasculpritlesionsweretherightcoronaryartery(P=0.005),theleftmaintrunk(P=0.040),oramultivesselcoronaryarterydisease(P=0.044).MultivariateanalysisshowedthatgroupIpatientshadasignificantlyhigherriskforbothall−causedeath(P=0.006)andcardiacdeath(P=0.003).PatientswithHR80 bpm also had higher mortality rates (P=0.0272 for general mortality and P=0.0280 for cardiac mortality). Conclusion: The present study suggests that SBP ,105 mmHg and HR $80 bpm at admission of STEMI patients are associated with a higher risk of in-hospital death, even after primary PCI.
Journal of Hypertension, 2006
on behalf of the GISSI-Prevenzione investigators Objectives Although the negative prognostic implication of a clinical history of arterial hypertension in myocardial infarction (MI) survivors is well known, the predictive role of the blood pressure (BP) regimen after MI is not well defined. The aim of this study was to investigate the prognostic significance of different BP indices in post-MI. Methods and results We evaluated the relationship between baseline systolic, diastolic, pulse and mean arterial pressure (MAP), measured by sphygmomanometry at discharge from hospital or within 3 months of an MI, and total and cardiovascular mortality in 11 116 patients enrolled in the GISSI-Prevenzione trial. Over 3.5 years of follow-up, 999 patients died, 657 of them from cardiovascular causes. Low mean and high pulse pressure were significantly associated with total and cardiovascular mortality after controlling for potential confounders in the multivariate analysis. As compared with patients with less extreme BP values, patients with MAP of 80 mmHg or less (n U 1241; 11.2%) had a 48% higher risk of cardiovascular death [95% confidence interval (CI) 1.16-1.87; P U 0.001] and those with pulse pressure greater than 60 mmHg (n U 958; 8.6%) had a 35% higher risk (95% CI 1.09-1.69; P U 0.007); only four subjects (0.04%) had both a high pulse pressure and a low MAP (relative risk of cardiovascular death 3.48; 95% CI 0.48-25.88; P U 0.218). Conclusions Our results show for the first time an additional prognostic importance of two easily measurable components of BP, definitely high pulse pressure (> 60 mmHg) and low MAP (<-80 mmHg), in a large sample of non-selected patients surviving MI who entered a modern programme of cardiovascular prevention.
Initial hospital pulse pressure and cardiovascular outcomes in acute coronary syndrome
Archives of Cardiovascular Diseases, 2011
The association between admission pulse pressure (PP) and cardiovascular outcomes in acute coronary syndrome (ACS) is not well defined.To explore the prognostic value of initial PP in ST-segment elevation myocardial infarction (STEMI) and non-ST elevation ACS (NSTE-ACS).Over a 5-month period in 2007, 6704 consecutive patients with ACS were categorized into five groups according to initial PP: P1, PP ≤ 0; P2, PP 31–40; P3, PP 41–50; P4, PP 51–60; P5, PP > 60 mmHg. Patient characteristics and in-hospital outcomes were analysed.Mean PP was lower in men versus women (55 ± 19 vs. 61 ± 22), young versus old (53 ± 17 vs. 59 ± 21), STEMI vs. NSTE-ACS (51 ± 18 vs. 60 ± 18) and patients who died versus survived (46 ± 22 vs. 57 ± 19 mmHg) (P < 0.001 for all). Most patients with low PP had a high Global Registry of Acute Coronary Events risk score. Compared with P5, crude odds ratios (ORs) (95% confidence intervals) for death were: P1, 9 (5.78–13.35); P2, 3 (1.71–4.06); P3, 1.5 (1.01–2.49); P4, 0.90 (0.51–1.58). After adjustment, low PP was associated with high mortality and stroke rates in ACS (adjusted ORs 7.5 [3.77–14.72] and 4.5 [1.20–18.88], respectively), high rates of recurrent ischaemia in NSTE-ACS (adjusted OR 2.8 [1.52–5.22]) and a high heart failure rate in STEMI (adjusted OR 2.1 [1.18–3.76]). Women with low PP had a higher mortality rate than men.In ACS, all blood pressure variables were significantly correlated. Low PP was an independent predictor for stroke and mortality in overall ACS. Although PP was not superior to systolic blood pressure, only low PP was an independent predictor for recurrent ischaemia in NSTE-ACS.L’association entre la pression pulsée à l’admission et les évènements cardiovasculaires au décours d’un syndrome coronaire aigu n’est pas bien connue.Évaluer l’impact pronostique de la pression pulsée à l’admission chez des patients ayant un syndrome coronaire aigu avec (STEMI) ou sans sus décalage du segment ST (NSTE-ACS).Pendant une durée de cinq mois, 6704 patients consécutifs ayant un syndrome coronaire aigu ont été répartis en groupes en fonction de la pression pulsée à l’admission : P1 pression pulsée ≤ 30, P2 PP 31–40, P3 PP 51–60, P5 PP > 60 mmHg. Les caractéristiques de base de ces patients et les évènements cardiovasculaires en phase hospitalière ont été analysés.La pression pulsée moyenne était significativement moindre chez les hommes comparativement aux femmes (59 ± 19 vs. 61 ± 22 mmHg), chez les patients jeunes comparativement aux sujets âgés (53 ± 17 vs. 59 ± 21 mmHg), en cas de STEMI versus NSTE-ACS (51 ± 18 versus 60 ± 18 mmHg) et chez les patients décédés comparativement aux survivants (46 ± 22 vs. 57 ± 19 mmHg) (p < 0,001 pour l’ensemble de ces variables). La majorité des patients ayant une pression pulsée basse avaient un score GRACE élevé. Comparativement au groupe P5, l’odd ratio non ajusté (ORs) (IC 95 %) était le suivant pour les décès P1, 9 (IC 95 %, 5,78–13,35) ; P2, 3 (IC 95 %, 1,71–4,06) ; P3, 1,5 (IC 95 %, 1,01–2,49) ; P4 0,90 IC 95 %, (0,51–1,58). Après ajustement, la pression pulsée est associée à une surmortalité de risque accru (ORs 7,5, IC 95 % 3,77–14,72) et à un taux accru d’AVC 4,5 (1,20–18,88), avec un taux plus élevé de récidive d’ischémie dans le syndrome coronaire aigu sans sus décalage du ST, NSTE-ACS (OR ajusté 2,8 [IC 95 %, 1,52–5,22]) et un taux accru d’insuffisance cardiaque chez les patients ayant un STEMI (odd ratio 2,1 [IC 95 %, 1,18–3,76]). Les femmes ayant une pression pulsée moindre avaient un taux de mortalité augmenté comparativement aux autres.Dans le syndrome coronaire aigu, toutes les variables dérivées de la pression artérielles sont significativement corrélées. Une pression pulsée basse est un prédicteur indépendant du risque d’AVC et de surmortalité quel que soit leur type de syndrome coronaire aigu. Bien que la pression pulsée ne soit pas supérieure à la pression artérielle systolique, seule une pression pulsée basse est un prédicteur indépendant de la récidive ischémique dans les syndromes coronaires aigus sans sus décalage de ST.
Indonesian Journal of Medicine
Background: Arterial blood pressure is an easily get variable, including systolic blood pressure, diastolic blood pressure, mean arterial pressure (MAP) and pulse pressure (PP). Although the variable blood pressure has clinical importance in many cardiovascular diseases, the variable that has become the best predictor in clinical practice cannot be determined. The purpose of this study is to determine the prognostic value of PP and MAP at the start of hospitalization in patients with acute myocardial infarction (IMA). Subject and Method: This was a retrospective cohort study conducted at cardiovascular intensive care unit, Dr. Moewardi Hospital, Surakarta, Central Java. A sample of 150 IMA patients from July 2013 to December 2013 was selected for this study. Blood pressure was measured the first time the patient arrives at the emergency unit to determine the value of PP and MAP. Then the patient was observed by looking at mortality during hospitalization as a final result. Basic characteristics data were analyzed using logistic regression and displayed in quartile form. The Kaplan-Meier curve was used to see mortality in each quartile. Cox proportional regression analysis was used to see the magnitude of the risk of variable PP, MAP and other variables on mortality. Results: The highest mortality was found in the first quartile group of PP (OR= 1.81; p<0.001) and MAP (OR= 1.69; p<0.001). The Kaplan-Meier curve showed the first quartile of the two groups had the lowest survival, while the third highest quartile (p <0.001). The results of the cox analysis showed a decrease in mortality risk of 0.49 per increase in PP by 10 mmHg (95% CI= 0.07 to 1.00; p= 0.044) and 0.31 each increase in MAP by 10 mmHg (95% CI= 0.09 to 0.53; p= 0.003). Conclusions: Blood pressure measurement can produce two variables as predictors of mortality in IMA patients, namely PP and MAP. Low PP and MAP are associated with higher mortality during hospitalization in IMA patients.
Prognostic value of pulse pressure after an acute coronary syndrome
Atherosclerosis, 2018
Pulse pressure (PP) is a surrogate of aortic stiffness (AS) easily obtainable. The link between AS and cardio-vascular disease is documented, however, data regarding acute coronary syndrome (ACS) patients are scarce and contradictory. We aimed to assess the prognostic value of PP measured at admission, with regard to major adverse outcomes (all-cause mortality, recurrence of MI, and stroke), during the first year following an acute coronary syndrome (ACS). The SPUM-ACS project is a prospective cohort study of patients with ACS conducted in 4 Swiss University hospitals. Patients with no PP at admission or with severe clinical heart failure or cardiogenic shock were excluded. Cox regression analyses were performed to determine associations between PP and outcomes (all-cause mortality, recurrence of myocardial infarction (MI), and stroke). Three multivariate Cox regression models were adjusted for hemodynamic, cardiovascular, and non-cardiovascular confounders, added successively. Of 5...
Relation of pulse pressure and blood pressure reduction to the incidence of myocardial infarction
Hypertension, 1994
The prognostic value of pretreatment pulse pressure as a predictor of myocardial infarction and the relation of pulse pressure and in-treatment diastolic blood pressure reduction to myocardial infarction were investigated in a union-sponsored systematic hypertension control program. In a prospective study, 2207 hypertensive patients with a pretreatment systolic blood pressure greater than or equal to 160 mm Hg and/or diastolic pressure greater than or equal to 95 mm Hg grouped according to tertile of pulse pressure (PP1, < or = 46; PP2, 47 to 62; PP3, > or = 63 mm Hg) were further stratified by the degree of diastolic fall: large (L), > or = 18; moderate (M), 7 to 17; small (S), < or = 6 mm Hg. During an average follow-up of 5 years, 132 cardiovascular events (50 myocardial infarctions, 23 strokes) were observed. Myocardial infarction rates per 1000 person-years were positively related to pulse pressure (PP1, 3.5; PP2, 2.9; PP3, 7.5; PP3 versus PP1, P = .02). Wide pulse pressure was identified as a predictor of myocardial infarction (PP3 versus [PP1 + PP2]: relative risk [RR] = 2.2, 95% confidence interval [CI] = 1.2-4.1), controlling for other known risk factors by Cox regression. A curvilinear relation (resembling a J shape) between diastolic fall and myocardial infarction was observed in patients with the widest pulse pressure, PP3 (L, 9.5; M, 3.9; S, 11.2; L versus M: RR = 2.5, 95% CI = 1.0-6.2; S versus M: RR = 2.9, 95% CI = 1.1-8.0).(ABSTRACT TRUNCATED AT 250 WORDS)
Journal of cardiovascular medicine (Hagerstown, Md.), 2017
The risk of death in patients affected by ST-elevation segment myocardial infarction (STEMI) is well known, but more data are required to define the in-hospital mortality in special subsets. We sought to assess the prognostic value of indicators in patients with large anterior STEMI as a first acute coronary event, undergoing percutaneous coronary intervention (PCI) and intra-aortic balloon pump (IABP). We evaluated 48 consecutive large anterior STEMI patients admitted as first acute coronary event, undergoing in acute phase both PCI and IABP. Patient demographics, clinical, noninvasive and invasive findings, together with in-hospital complications, were collected. Moreover, findings obtained after a 24-month follow-up were reported. The primary endpoint was in-hospital mortality, whereas the secondary endpoints were out of hospital mortality, rehospitalization for heart failure or reinfarction, and New York Heart Association (NYHA) class at least 2 at follow-up visit. The univariat...
The American Journal of Cardiology, 2011
Measurement of left ventricular end-diastolic pressure (LVEDP) is readily obtainable in patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI). However, the prognostic utility of LVEDP during primary PCI has never been studied. LVEDP was measured in 2,797 patients during primary PCI in the Harmonizing Outcomes with RevascularIZatiON and Stents in Acute Myocardial Infarction (HORIZONS-AMI) trial. Outcomes were assessed at 30 days and 2 years stratified by medians of LVEDP. Multivariable analysis was performed to determine whether LVEDP was an independent determinate of adverse outcomes. The median (interquartile range) for LVEDP was 18 mm Hg (12 to 24). For patients with LVEDP &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;18 mm Hg versus those with ≤18 mm Hg, hazard ratios (95% confidence intervals) for death and death or reinfarction at 30 days were 2.00 (1.20 to 3.33, p = 0.007) and 1.84 (1.24 to 2.73, p = 0.002), respectively, and at 2 years were 1.57 (1.12 to 2.21, p = 0.009) and 1.45 (1.14 to 1.85, p = 0.002), respectively. Patients in the highest quartile of LVEDP (≥24 mm Hg) were at the greatest risk of mortality. Only a weak correlation was present between LVEDP and left ventricular ejection fraction (LVEF; R(2) = 0.03, p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.01). By multivariable analysis increased LVEDP was an independent predictor of death or reinfarction at 2 years (hazard ratio 1.20, 95% confidence interval 1.02 to 1.42, p = 0.03) even after adjustment for baseline LVEF. In conclusion, baseline increased LVEDP is an independent predictor of adverse outcomes in patients with STEMI undergoing primary PCI even after adjustment for baseline LVEF. Patients with LVEDP ≥24 mm Hg are at the greatest risk for early and late mortality.
BMC Cardiovascular Disorders, 2023
Background ST-elevation myocardial infarction (STEMI) is a major public health problem. This study aimed to determine the prevalence and identify the determinants of STEMI-related complications in the Cardiology Intensive Care Unit of the Sud Francilien Hospital Center (SFHC). Methods We retrospectively analyzed the data of 315 patients with STEMI aged ≥ 18 years. Logistic regression was used to identify factors independently associated with the occurrence of complications. Results Overall, 315 patients aged 61.7 ± 13.4 years, of whom 261 were men, had STEMI during the study period. The hospital frequency of STEMI was 12.7%. Arrhythmias and acute heart failure were the main complications. Age ≥ 75 years (adjusted odds ratio [aOR], 5.18; 95% confidence interval [CI], 3.92-8.75), hypertension (aOR, 3.38; 95% CI, 1.68-5.82), and cigarette smoking (aOR, 3.52; 95% CI, 1.69-7.33) were independent determinants of acute heart failure. Meanwhile, diabetes mellitus (aOR, 1.74; 95% CI, 1.09-3.37), history of atrial fibrillation (aOR, 2.79; 95% CI, 1.66-4.76), history of stroke or transient ischemic attack (aOR, 1.99; 95% CI, 1.31-2.89), and low high-density lipoproteincholesterol (HDL-C) levels (aOR, 3.70; 95% CI, 1.08-6.64) were independent determinants of arrhythmias. Conclusion STEMI is a frequent condition at SFHC and is often complicated by acute heart failure and arrhythmias. Patients aged ≥ 75 years, those with hypertension or diabetes mellitus, smokers, those with a history of atrial fibrillation or stroke, and those with low HDL-C levels require careful monitoring for the early diagnosis and management of these complications.
The American Journal of Cardiology, 2004
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